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0007-026 (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 634931. j ( 01i?1121 ,t Date'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: a. ( ) 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. i construct the project (Sec. 7044, Business & Professionals Code). r-, . () 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 STATE FWID Policy No. 1`S42937 -p0 (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 with those provisions. Date: ' a -+ 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. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant,io 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 the above-mentioned property fo�inspection purposes. Signature (Owner/Agent).l �t/' - Date / �•�` BUILDING PERMIT PERMIT" , DATE VALUATION LOT (M?" 02''9 TRACT "9,3'.45.10 4 BIK1 h'2 U1 S JOB SITE ADDRESS .53-335 AVENWA JUAPM, APN 774-034-0146 OWNER CONTRACTOR / DESIGNER / ENGINEER Ct.WM M`ffiiRPR M CORONEL CONS 1 ZLI TON P O I30 51; 51-540 FASENIMWER bit. LA Q1:7WTA Cly 9225 3 uoi. Qi1:12+1' .& CA 92253 ('i60)5644604 C -:L# 2261 x USE OF PERMIT , SINGIX FAMILY DWELLNCa SYD-PERMIT DOES NOT INCLUDE i31,OC:1ti'WX L OR POOL TRACT CONSTRUCTION ION 1,411.00 SF PORCH/PATIO I.M.00 Sir CA11,P OFICAeRPORT (0) 9,gmo 3 FT. WOOD "—WCE 200.00 LF ESTIZVTA13M COST OF CONS.i1MCTT.E9N 89,3.35.10 CONSTRUCTION FLEE. 101-000-41&0100 6594.50 PLAN CHECK FEE ; 101-000-439.348 $Sit0.12 'f INS EC ANICALF P 101-000-421-000 $60.611 RL,2rMICAL FEE 101-000-420--000 $129,44 PLUMBT'.A(F FZE 1€11-000-419.000 $110.15 ST12C71a(.a MWI014 ME - RESID 101=000-241-000 $3.03 (MADING FER 101-000-423.000 520A 13EVEWPER IMPACT "ItE $1,907-00 PREC182 PLAN 101.000.441.345 $100,00 PEE DEPOSIT 101-000.499-3113 •5250.x0 SIM-lMrAL 1`3 1t&I'CTlOR AND PLAN CHFM $3,430:74 r L=13 PRE, -PAID FM 4210.00 t . PAI 1`OT'AL rERIM VMS DUE NOW 93,180:74 JUL 19.2000 " ITY(JF LA QUINT RECEIPT L! DATE BY DATE FINALED INSPECTOR t g INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs r- Forms & Footings :Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck z L- crw S_ Exhaust Fans OX to Wrap Framing Insulation � � /6T% �"j/L -� - �.S z _ � �� F.A.U. Compressor Vents Fireplace P.L. Grills Fireplace T:O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath D Z a✓7 Final .L— �� _ 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 Gas Piping PLUMPING APPROVALS Gas Final Electric Waste Lines Water Piping - Heater Final Plumbing Final Plumbing Top Out - - Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection Gas Piping- Encapsulation 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. :x I:. Smoke Detectors - Temp. Use -of Power Final Utility Notice (Perm) �� Building Address Mailing Address P G7 Y City Zip Contractor \ ty Zip it Tel. State Lic. `r�� CA , — & Classif. ( City Arch., Engr., Designer Address rr= Tel. q City Zip State r Lic. # Lic. # Z P.O. BOX 1504 _ APPLICATION ON Y / 76-495 CALLE TAMPICO ZLA QUINTA, CALIFORNIA 92253 BUILDING: TYPE"CONST. OCC. GRP. A.P. Number - I �' b� t — �� Legal Description Lh�� //'' r r \ t tA Project Description `'1 t Sq. Ft. No. No. Dw. Stories Units New ® Add 0 Alter 0 Repair 0 Demolition 0 LICENSED CONTRACTOR'S DECV114ATION ) that I am Iloensed undofDJovisions of Chapter9�(comm hcing with Sect 3 of the usine s a d Professio s' Cade; and m licen a is in iG force I OWNER ;BUILDER DECLARATION I hereby affirtm that' I am exempt from the Contractor's License Law for the following reason: (Sec. 7034'5; Business 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).' a .' 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 or improves thereon and who doestsuch 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.) . 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.) i 7 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 n Copy is filed with the city. 0 Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE t (This section need not be completed If the permit is for one hundredrdofilars ($100) valuation or less.) , I 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: If, atter making this Certificate of Exemption you should become subject fo 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 9 This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. t., . _. I certify that I have read this application and slate 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 3timated Valu atidn 4 b PERMIT AMOUNT Plan Chk. Dep a o Plan Chk. Bal. Const. Mech. g Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure N 4 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 FINAIPA INSPECTOR Iss+tde�b. A Date Permit aa//uu e7 Validated by: �h .� A ry Hof, WHITE= FINANCE YELLOW = APPLICANT PINK =BUILDING DIVISION i 0 Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 ' Date 7/19/00 No. 20738 Owner NameCornel Enterprises CERTIFICATE OF COMPLIANCE APN # 774-034-016 Jurisdiction La Quinta Permit # No. 53-335 Street Avenida Juarez Log # City La Quinta zip 92253 Study Area Tract # Lot # 4 Square Footage 1421 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: n EXEMPTION NOT APPLICABLE y� This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,421 or $ 2,913.05 the property listed above and that building f permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued; Fees Paid By cc Telephone 564-4604 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Sheryl Simmons Signature Payment Received $2,913.05 Check No. 216575 110'nCE: Pursuant of Assembly Bill 3081 (CHAP 548, STATS. 1998) this will serve to notify you that the 9t1 -day approval period in which you may protest the fees or other payment identified fbove 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 milect them on the Distdct('sxa') 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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting 06/01/00 THU 13:55 FAX 1 760 568 9610 _ PACIFIC COAST NO.33::� r . ..`JUN. 1.2000 12:2GPM CTC SUBDIVISION AND PAYOFFS I * h ItQL.CAG v Ai J J D RECORDING REQUESTED BY: - C, AND WHEN RECORDEP, MAIL, TO: Coronel EnCerprises, Irse_ P.O. Box 389 La Quints, CA 92253 on ��es No - Has r,ot been compared with original. GARY L. ORSO Countv Recorder 0%nfr-oeir.c c0UNTVF CA -24. A Q002 r - ASSESSOR'S PARCEL NO.: 17403401.6_ The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER TAX IS: TrT;:nRDERNO.: 2020214 R� -I1�S ng-65County $ City ESCROW NO.; 19661-004 GRANT DEED .. computed on the full value of the Interest of property conveyed, or — computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale OR transfer is EXEMPT from tax far the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Henry C, GriswoldeC as Trustof the Henry Griswold Living Trust established pursuant to that certain document entitled "Declaration of Trust" dated ,?use 19, 1995, and executed by hereby GRANT(S)to Henry C. Griswold,as Trustor and Truetee- Corottel Enterprises, Inc. ail that real property situated In the City of La Quinta County of Riverside 1 1, State of Califomla, described as: LOT 4 IN BLOCK 182 OF SANTA CARMELITA AT VALE LA QVINTA, UNIT No- Is As SHOWN BY MAP oN SZLE IN BOOR 19 PAGES 31 QF MhPs, RECORDS OF RIVERSIDE COUNTY, CALIFOR91A Dated April 21, 2000 STATE OF CALJPJDFINIA, COUNTY OF6I 165 OrA before me Notary Pyblic, personally appeared person,ally, known to me (o , l satlslgctogF-. d&P,®e) to be the person(s) whose name(s) Is/are subscribed to the within instrument and acitnowledged to me'that he/she/they executed the same i his/har/their authorized capacity(les), and his/her/ air slgnawre(s) on the, Instrument the pe n(s), o he ent' upon behalf of which the person(s) a , exec Mont I WITNESS my h sea RUIN A. FURST to m COMM, ti11B09D� wveRsidecrY.lWrr Qui at Ny cpm, a�� rc.o� aooQ Signature v ! �- `��- v Rhe umrauAdal „otayee.q MAIL TAX STATTS T0: SAME AS ABO Oft'r,eTA7sgZIP NAME ADM&S ��rirrrrrrwrrrrrr �� rrrrrrrrrrrrs� Q002 r - ASSESSOR'S PARCEL NO.: 17403401.6_ The undersigned Grantor(s) declare(s) that the DOCUMENT TRANSFER TAX IS: TrT;:nRDERNO.: 2020214 R� -I1�S ng-65County $ City ESCROW NO.; 19661-004 GRANT DEED .. computed on the full value of the Interest of property conveyed, or — computed on the full value less the value of liens or encumbrances remaining thereon at the time of sale OR transfer is EXEMPT from tax far the following reason: FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Henry C, GriswoldeC as Trustof the Henry Griswold Living Trust established pursuant to that certain document entitled "Declaration of Trust" dated ,?use 19, 1995, and executed by hereby GRANT(S)to Henry C. Griswold,as Trustor and Truetee- Corottel Enterprises, Inc. ail that real property situated In the City of La Quinta County of Riverside 1 1, State of Califomla, described as: LOT 4 IN BLOCK 182 OF SANTA CARMELITA AT VALE LA QVINTA, UNIT No- Is As SHOWN BY MAP oN SZLE IN BOOR 19 PAGES 31 QF MhPs, RECORDS OF RIVERSIDE COUNTY, CALIFOR91A Dated April 21, 2000 STATE OF CALJPJDFINIA, COUNTY OF6I 165 OrA before me Notary Pyblic, personally appeared person,ally, known to me (o , l satlslgctogF-. d&P,®e) to be the person(s) whose name(s) Is/are subscribed to the within instrument and acitnowledged to me'that he/she/they executed the same i his/har/their authorized capacity(les), and his/her/ air slgnawre(s) on the, Instrument the pe n(s), o he ent' upon behalf of which the person(s) a , exec Mont I WITNESS my h sea RUIN A. FURST to m COMM, ti11B09D� wveRsidecrY.lWrr Qui at Ny cpm, a�� rc.o� aooQ Signature v ! �- `��- v Rhe umrauAdal „otayee.q MAIL TAX STATTS T0: SAME AS ABO Oft'r,eTA7sgZIP NAME ADM&S t� . 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, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT CORONEL CONSTRUCTION SITE ADDRESS 53-335 Juarez APN 774 _ 034 _ 016 BINNO.: I CASE NO.: 2000-255 LEGAL: LOT CHECKED BY: 4 BLOCK - 18 2 Greg Trousdell UNIT 18 DATE: S.C.@V.L.Q. Inform the assigned Building plan checker upon your to this case. The CDD Executive Secretary maintains a log book to track applicati and assign case num ers. REQUIRED ITEM Y OMMENT/CORRECTION. Compatibility Review Case logged and number assigned Verify, legal and APN information Consistent with MDG on file (as applicable MDG filing required (5 filings since 9%3/98) Consistency with street/surrounding area: Colors Materials c flecture �� 0 S %(/C— Other Requirements: / CK f `L 7 A .. 9 City of LaQuinta. 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:, 53-335 AVENIDA JUAREZ Use Classification: SFD Occupancy Group: R 3 Type of Construction: Owner of Building: CORONEL ENTERPRISES Build ing'Official Bldg. Permit No.: 0007-026 Land Use Zone: RC Address: P.O. BOX 389 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 12-04-00 POST IN A CONSPICUOUS PLACE