9806-005 (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----�.
634981 13 / ti31i 0
Date f ' E2 4 -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).
( ) 1, 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
performs ce of the work for which this permit is issued.
( LA -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.
1
fsC),I, :i rJ ACi�.(E, IR,. NWC42189 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 anyimanner so as to become subject to the
workers' compensation laws of California, and agree PSt if I should become
subject to the workers' compe sn at�on provision�s�of Section 3700 of the Labor
Code, I -shall forthwith- s
comply with provision}
Date: � - —,/EE pplicant •y` e
Warning: Failure to secure Workers' Compensationcoverage is unlawful and
shall subject an employer to crimin'a'l 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 af�l '
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
the above-mentioned propert'yyfor inspectiowpurposes.
j
Si nature (Owner/Agerit�/ f - � Z Date
BUILDING PERMIT PERMITA
CONTROL#
806-05
DATE VALUATION ,S$9.413.5s) LOT 11 TRACT 1�fM*6
111,I VV ''TTT �i
67 14 IQ A
'JOB SIA y' r�
ADDRESS 1:-� A��JII .is i��+A.
APN 774-034-62�!
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CC R011ll . C:OI i.;1°RUCTON
C:OItONEL CO STIIi.K"i'tON
:51-540EISENHOWER DD.
:Si -540 B1SE?vfiOWER Mt.
1..A• QUINTA CA, 92453
LA (;SUR TM CA 92M
C160)564 160)5641 460 9 COLO 2261
USE OF PERMIT b
S03 - .F'MNf:1'T JDOR:i NOT INC1.Y.iia;C 1 ocl, bGriux OR POOL.
.,LTIt3.L
(MA Xrr-.R.# f) R,60006) t-,111 CX .riU_4i Foxz.MULTIPLE.
3U11M1.TMIL
TRA .I, cl t4S RILIC.'.1`.10114 .1,421,.L1t) 5F
PORCFfiMM, 16,00 SF
Gi A AGEfc; A42 i:'QR.1' 514.00 ;iia
6FT. Vd0001 FENCE 200.001.F`
LI..Y l il7:lN YE'D 6.09f O6' CY1MS1171=.A10R'i
39,4.i.c .50
P UR"6',s 1t 'PRIT, a 4'UNT'IN9'.�:r� RI
COrNS'1'RUC11E3N 170-s t01-0100-49.8AX)o $594.50
tdf,r`tTF rv+:11'�'fs x'►:', � n1..�Ztl>c1�G�.i1 R �12,5,rft
81411 %1,rNf4tC,A3.:tT_fl 1()1-000-421-000 $53.50
1:t ECS A1c A1.141sg 106-000420-000 $123.52
p i,t 4 #131NC1:1" 1 Q 1-iJ1 i-�I t )r0t)t1 $133, 50
jtfl)1F1t'1V1�+AyIE<t�fpj�f/��
,101.-000-4?.3�-000
11th:. -*R V.Y.!"ci3f;.i'd:)Tdy F1�z25� 000.443.342 sj,.i 66178
tjf&FAi I SE P), AN 101 �000-441-345 $25.00
1, 1%. n!,PoSIT 10.1-t 00-439-1.1ft 42".01)
u
PAIIJ 1i X..A.1p L, �1N� �ti3C";.'?OO AMD PLAN CtjEC K,
€ti :,ESS MU -'AD EE
415000
►i,
JUN -0 3 19981'. lb -T , VEX'S DIA4 NOW
$2,79.7.42
1TY OF LA 0U1NTAa
� t
RECEIPT
DATE b gBy/
qM�
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
Insulation
Compressor
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 S
BLOCKWALL APPROVALS
Steel POOLS =SPAS
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 Q
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral /6
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
c
Final ,gyp
Utility Notice (Perm)
COMMENTS:
- P.O. BOX 1504
Building y 78-495 CALLE TAMPICO APPLICATION ONLY
Address M^rLA QUINTA, CALIFORNIA 92253
Owner
CORONEL CONSTRUCTION
Mailing P.O. BOX 389
Address
City LA QI z.Ip I el.
&Y/- /-r&0
Contractor CORONEL CONSTRUCTION
Address P.O. BOX 389 1
L:ny
Lip
lel.
5 6 1,(- Z16
State Ljc.n (%1
& Classif. 7 a/
City -2
Lic. # I
Arch., Engr.,
Designer
Sq. Ft.No.
Size
Address
—TT—el-
No. Dw. /
Units
city Zip State I
..2-40 4 .- Lic. If
LICENSED CONTRACTOR'S DECLARATION
I herpl,y affirm that I am Ilcensed under provisions of Chapter 9 (con)mencing with Section
7000) of•eivison•3 of the Business and Professions Code, and mylic fin is i/N/fdl farce and
effect f_.�•+,•.. d7 r.,,., �:
SIGNATURE �TDATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.8usiness and Professions Code: Any city or county which requires a
permit to construct, after, 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 70.70) 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
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 1 I, as owner of the property, am exclusively contracting with licensed contractors 10 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.)
1-1 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. O 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.)
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.
Date Owner
NOTICE TO APPLICANT: If, after 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 it 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 applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE"CONST.. OCC. GRP.. �t
A.P. Number -2-2 - 0 /3 �y 1 �/
Legal Description /. // . Z.I�K.. 1 I U/ I
Project Description
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:
Validatio
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
,
2
�b
Sq. Ft.No.
Size
Stories
No. Dw. /
Units
Ne-YefAdd
Alter ❑
Repair ❑ Demolition ❑
^❑
Estimated Valuation
w -
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
f r
Const.
Mech.
its t '
Electricals
Plumbing
r
S.M.I.
Grading
Driveway Enc.
Infrastructure
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validatio
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
,
2
Desert Sands Unified School District
-Notice• 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/3/98
No. 17116
Owner NameCoronel Construction
No. 53-465
City La Quinta
Tract #
Type of Development
Comments
APN # 774-034-023
Jurisdiction La Quinta
Street Avenida Juarez
zip 92253
Lot #
Single Family Residence
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 pr9jeet ay `now be issued
Fees Paid By Cashier CheckNIB/Coronel Construction : •, Teleph ne 564-4604'
Name on the check ,•rN1C , ;
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,742.53
Check No. 166119
Signature
NOTICE: Pursuant of Asse ty 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 identifiedabove will begin to run fro a 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
03/22/1994 22:06 6195644202
1. 1-398 4; 34PM COh?MONWEAt-TH
�f ��e pany
rim hsa Waft by., MO AS
rdm Dan% CA PWO
(?60%mma . rhm -
(1601341-3315- fts
CORONEL CONSTRUCTION
M �� Sr
S3
ESCROW AMZNDMENT/SUPPLEMENT
PAGE 01
r•.r,. 1` 1. F . !
Escrow No. : 98.7564KC Date- June 1, 1998
Escrow Officer: Kelly Collier
Property : APN 774-034-023.2. LA QUINTA. CALIFORNIA 32253
TO: COMMONWEALTH LAND TITLE COMPANY
My previous instructions in the above numbered escrow are hereuy modified and/car
supplemented in the follow ng particulars only:
THE LEGAL. DESCREPTION IS AMENDED TO BE: APN 774-034.023
LOT 11 OF BLOCK 182 OF SANTA CARMELITA TA VALE LA QUINTA. UNIT h0. Ill. AS
SHOWN BY MAP ON FILE IN BOOK 19, PAGE 31 OF MAPS, RECORDS OF RIVERSIDE
COUNTY, CALIFORNIA
All other terms and conditions not in direct conflict wit' the foregoing renain
unchanged.
BUYERS? SIGNATURES):
• Each of the above -.signed states he has read the foregcing irstructions aid
understands and agrees.to them.
If
03/22/1994 22:06 6195644202 CORONEL CONSTRUCTION PAGE 02
1 .. V'79i -+: �urrt l Vr'I"IUPIWtN_ I M h i lt•1 i . -
y
RECOP41NO REQUESTED BY:
OLD RBMMLZC TITLE CWACGMP=Y j
98.1)S64xC 109439-19
y
ONt U
BILL CON"y
and DLWE A. CCUWAY
SPACE ABOVE THIS LINE FOR RECOROER'�
GRANT DEED
The underaiQned grantor (a) declare (g)
Documentaxy transfer -ax is
(�aat► co uted on full value of property conveyed, or
Ce�uted on full value less liens and encumb-rances remaining at time c: e:o-o.
t ) Unincorporated area: ( ) City of an:i
FOR A VALVULg CONSIDERATION, receipt of which le hereby ac:tnowledged,
ESEQUIRL M. CORCME:,, A SINOLB MM
hereby ORAEiT(S) to
BILL CONWAY and DIANS'A. CONWAY,
the real properry in the CiCy of LA QUMTA, County of Riverside, State of C litcrnia,
described as:
LOT 11 IN BLOCK 182 OP SM -A CARMEL:TA Al VALE :A QUINTS, UaI: 140.18, AS 2ER
MAP RECORDED IN HOOK 19, PACT 31 OF MAPS RECORDS OF RIVERSME CCtMTY, CALIF0�N:[A
Dated June 1. 1998
State of California
County of ) S.S.
On
before me,
personally appeared
pereor:ally known to me (or proved tome or,
the babis of eatialactory evidence) to be
the person(*) whose name(a) ie/are Subscribed
to the within instrument and acknowledged to
ne that he/she/they exacuted the name in
his/her/their authorized Capacity(les), and
that by hie/her/their tiMuture(s) en the
instrument the person(s). or the entity upon
behalf of which thv personts) acted, executed
the instrument.
WI'T'NESS my hand and official seal
Signature
MAIL TAX STATMNTS TO:
DUI . CORONEL
(This area for official notarial seal;
k" 9f.3:17 r NU. 7137
Cooperative Red Imported Fire Ant Project
- Notification of Intent to Move Soil from or within Quarantined
Areas of Orange, Riverside, and Los Angeles Counties
RIFA Compliance Agreement #
Permit #
Issuing City/County
Agency
Name of Company Requesting Approval: j3L VE 14 A V E/V P.oks
Contact Person: 5144 AVE G
Address: .23/9 V IN E Y4P_ b AVE.
City: ON i p Jel U (�A zip: 9 /7 (ol
Telephone: _' �!Ly 9 ) 9 V 7 — (o y7 q Fax: _ . g U `� ) g X17 - /3c33
Excavation Location:; 53 = N(o5 -446 vipV-Ju,9R67Z TB.:
L�4 C�V�Ntirl CA ACRES:
Destination Location:
SAfkl TB:
Estimated Quantity of Soil (e.g. # Cubic Yards):
Anticipated Date of Movement:
Urgency Level for Immediate Inspection and Release:
131
Movement of Soil is Permitted.
ACRES:
[Circle One] High
h
Medium Low
Hold Movement Until Site Checked - WE WILL CALL AS SOON AS POSSIBLE TO
SCHEDULE TM \1—'
CTION DATE AND TIME.
Date Trapped: g_ # of Traps: Trapped by: ^11
Date Picked Up: b4 J b Comments: Vt4 g#t 1N5P6(_T- PDR #:_
0 Soil Movement Strictly Prohibited for the Following Reason(s):
Acres:
Name of RIFA Project Regulatory Official: M"l LM -46L r"LOW-R-S Date: /0 — Z/-00
Signature:
Acv ai 1 3199 RiFA Foam CA, t
TS is Thomas Brothers page and grid designation
T.iill