9809-101 (SFD)LICENSED CONTRACTOR DECLARATION
-Fereby 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. Classxp: Date
/ '34981, 13 If3i100
;ate Signature of Contractor -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Cdntractor's
License Law for the following reason: i
( ) I, as owner of the property, or my employees with wages as their sole's
compensation, will do the work, and the structure is not intended or offered for It
sale (Sec. 7044, Busoess & Professionals Code). ,
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 1 ?
() 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 3709 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:
Gam6c t Policy No. n c
tst.�l.DLI ITI�::T..�; li,?15 s� Ar C: 3 x10'92°00 '
(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.shajl.not employ any person in any manner so as to become-jubject to the
workers' compensation laws of Califor�r' ia, and agree that if I should become
subject to the workers' compensation provisions of S bion 3700 of the Labor
Code, I shall forthwith comply with ih se prov'sions.
„Date: arm' Applicant "',.i; / n
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 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 1.80 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 wi all City, and State laws relating to the building
„co fruction, and herebyau orize represer4tatives of this City; to enter upon
the above-mentionedtprope for inspecti ri purposeess.
Signature (Owner/Agent) 7 f r rDate
BUILDINGPERMIT PERMIe#CONTROL#
DATE VALUATION $92,612,90 LOT I?I TRACT 0M.OY�f®�I
)f
q. !?�1 i1 82-
.ADOREfs,� 53.380 AVENiDA.JttMIEZ
APN 774-071-067
OWNER
CONTRACTOR/ DESIGNER / ENGINEER
C ril)Ohl,i. 1, I.JaI k ii45+1 t'1 J4:
51-540 EISENvI4OWE'R DR..
_31-540 EISENHOWER Dit
LA QUIIV'I'A CA 9.2252t
LA. (7LANTA, CA 92253
(760)5644604 C;i3.1,4 2261
USE OF PERMIT
.7 y
dJt1�UR
S?-D-1?EZMIT T. ORS'AIOT .INCt UDr., NLOC K WALL Oil POOL, COOM—L
sYlt�S Eft 03
TR.AC'r CONSMU +.'.COIti 1,485.00 S3
PORC:_WPIATIO 30.00 SF
+",3•ARAUI.IC:Afti't)RT 504.W SF,
6 FT. w00a0 i'RNC*F '200,00 LF
1`?'EERM'd'1t 3+' U S$.iIMM ARV
C:0'f1STRUCTION'I:EE 401 -W0•`418 -0W w6Si8.4v
PLAN M.C<JiF1i1: UA
IV.6 1•l NTIC;Ai 1- 3 101.-000421IM0 $53.50
&U...E.C.o - CyltI.3'+ SE M-00-4.20-000 $12,.66
.YILIUtb§:13f*t M'E )01-000419-000 $127.50 .
S11RO GNYTfc3ntFFF,-'RAMI-) 101-000-241-000 $926
CJit11DM31MS .101</(�1f00�- .23-000
pp��rrff ($«O.GC+
AA\0bX,J1'RUC`i'URl's FEx65 {•z ZiJ-000-443-3w2
PFCC11517S, PLAN . 101-000.444-345 $w5,09
A -f C!ONSTRUC,17'IONAND Pi.Av C.1il-C'IC
LESS "PREPAID FEES
-$250.00
64 a MAT, PERMIT( PUBS DUE NOW
:ANN�
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
r MECHANICAL APPROVALS
Set Backs r,
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrapfl f�
F.A.U.
Framing _
Compressor
Insulation _ _ �,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
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
Gas Piping
PLUMBING APPROVALS
Waste Lines 717
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test rt
Appliances
Final
COMMENTS:
Final _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Pourer Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
c
k
Final
Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated
Date 9/21/98
No. 17776
Owner NameEsequiel Coronel
No. 53-380 -,
City La Quinta
Tract #
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 774-071-007
Jurisdiction La Quinta
Street Ave. Juarez
zip 92253
Lot # Square Footage
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area
1485
No. of Units
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 1,485 or $ 2,866.05 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 CC/Esequiel Coronel
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino
Signature\�z�1,
Payment Receive
Check No
Telephony ';
re
4"
T00 -
r f.
d ''^$2-,866.05
r•'�h, r
176819
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
:ollecl them on the Dislrict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or,city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Pacific Coast Cscnow Conponation
74-920 HIGHWAY 111 INDIAN WELLS, CA 92210
TELEPHONE (760) 568-0344
ESCROW INSTRUCTIONS
Cindy Burgin
Escrow Officer
Escrow No. 18097
Date: August 13, 1998
This escrow company holds Department of Corporations Escrow License'No.
963-0473.
CASH THROUGH ESCROW ............................. ................$ 15,000.00•
TOTAL CONSIDERATION ...............................................$ 15,000.00
r
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 09/14/98, 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 Riverside, State of California:
LOT 18 IN BLOCK 183 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 18 AS SHOWN BY MAP
ON FILE IN BOOK 19 PAGE 31 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA
PROPERTY ADDRESS LOT 18, BLOCK 183,La Quinta,CA 92253
SHOWING TITLE VESTED IN: Esequiel M. Coronel, a married man as his sole and separate
property '
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 i
or reservations of oil, gas or mineral rights, if any. Any bonds or assessments of record.
1) . Buyer, herei.n..will, pay..;All Cash for._.subj.ect property, and shall deposit into escrow
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
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 way,
and easements for public utilities, districts, water companies, alleys, and !streets.
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, including 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 choice 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
funds wire transferred to close escrow without delay or additional interest expense.
6). SPECIAL CLOSING .INSTRUCTIONS AND RELEASE FROM BLANKET ENCUMBRANCE: This escrow shall
not close and funds shall not be released from impound until title to the lot has been
conveyed to the purchaser free and clear of any blanket encumbrance(s).
7). SPECIAL CANCELLATION INSTRUCTIONS FOR NON -DEFAULTING BUYER:
If, through no fault of the Buyer herein, this escrow shall not close within one year
from the date of the Agreement to Purchase, (signed by bother Seller and Buyer); Buyer
shall have the right to the return of all monies then deposited by him into escrow. r
SELLERR
S) INITIALS: BUYERS) INITIALS:_ _
W0600
_
' M
� i InfornzationM% .ToBuild On
Er�lrnor,fi�p • � • rtfi►s�
---
REPORT OF FIELD COMPACTION TESTS
fED FOR: ZEKE PROJECT:
COR014EL CONSTRUCTION
P.O. BOX 389
LA QUINTA, CA 92253
53-380 AVENIDA JTJARSZ
LA QUINTA, CA
E:
November 12, 1998
OUR REPORT NC.: 073- 80203 - 2
T DATA:
(1) Fine.silty sand
OPT.
MOIST. =
12.0% -
2.0%MAXINUM
isT
0.
TEST
DEPTH
ELEVATION
SOIL 10
NUMBER
MA X"UM
LAB DRY *
DENSITY
WATER
CONTENT
WET
--DENSITY
DRY
DENSITY
PERC!NT
COMPACTION
81'
F. G. *
1
115.0
11.5
116.0
104.0
90.4
1
115.0
11.3
117.4
105.5
91.7
1
115.0
11.4
116.9
104.9
91.2
811
FIG. *
1
115.0
11.3
117.9
105.9
92.1
iT LOCATION: Finish grade
South east corner of pad within building Linc
''North east corner of pad'within building line
North west corner of pad within building line
Approx center of pad
Tris. TESTS PERFORMED PER ASTM D2922 -E1 9 ASTM 03017.86(89) "COMMENTS: 1. FILL MATERIAL A TEST RESULT COMPLY WITH JpECIFtCAT10NS
DENSITIES SHOWN: lbs, per cubic foof� 2. BACKFILL B. PERCE`NT CC PACTION OURS NOT COMPLY
WATER CCONTENT: Percent of dw W019 t• 3, 8A E COURSE WITH�OOE I -ATIONS
PERCENT COMPACTION: Base on max mum dry 4. SUBBASE C. �RIEpT_; OF PREVIOUS TEST _
So lee obton•d on Sample indicated by 5. SOILECEMEN7 E NIOI�Tl1RISTURE BELOW SPECIFICATIONS EXCESS SPECIFICATIONS
401110 number. 8 R
+ (1) ASTM D-1557, Procedure A
STINSTRUMENT: Troxler, 3430, 25942 STANDARD COUNT M: 0:
;MARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: D.
**F.G.= Finish grade**
Respectfully submitted.
TECHNICIAN: Vicki Drover Professional Service Industries, Inc.
r.l
COMM CUTS'
Spec. 901k Min
11 A
1 - A
'1 - A
LSC TEIT RESVLTS APPLY ONLY W YK 'PECl/IC LOCA104 NOTED AND MAY NOT 111"MSENT ANY OYNER LOWMN5 OR &EVATIONS.
'on" MAY NOT bB NL'PROOVC•O, EKCEPT M PULL, VATHWY W 41rifN PERMISSION DY PROIERSMAL XRVICE INOUETRIP.S. INC,
.�... _ ...— ..__� ... ... �_..._.. .._-......... .._.._.._ ...._..__.. ._.... _... .... .... .... ... ..........
Professional Service Industries, Inc. • 42-240 Green way, Suite C • Palm Desert, CA 52211 • Phone 618/341-5790 • Fax 6181341-5794
+.Lao.: tax