9905-143 (SFD)!^ " LICENSED CONTRACTOR DECLARATION
_1 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
fi 4981 .6 U1F3 I1Gf
,pat / J> ('/e -t7 Signature of Contracts
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.
GOLIjct3'Ef1CIX INS, N' 3 fi-Od
(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' compensai provisidnssof Section 3700 of the Labor
Cod'/l shall forthwith comply with th�ose provi lonst
pat � !'_f r 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 tand 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 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 for irispectionipurposes.
Signature (Owner/ gen t / -^ i1 e ' T Date
BUILDING PERMIT PERMIT# _ 4
w ,
990 5-1143
DATE VALUATION LOT �Slj��al TRACT K 102
��
JOB SITE
ADDRESS Q F��,1i1�1�81e'1e7iJ�EEr+2a TPN
r4-111-027OWNER
CONTRACTOR / DESIGNER / ENGINEER
CC,3RO19EL CONS'IT'.RUC PION
::i�P.CyMil C0t,!S'1':t�pC'rI0NT
51-S40 E1Si:Nf1 Wr FJ :d)R.
51-540 EISENHOWER Dk.
LA. QUIMA ' -_ CA 922.53
1 QUINTA CA 92253
A
(760;)564-460 ! CBL# ' 261
USE OF PERMIT
SIAR LE 4LY DWELLIKO
Sid) T��: T 1NC� TME 13LOCK WALL OR WOL
t�
IN
"1*AC, ,C0W IrRUCT10N i,,8'30.f)r.D'SF
[�OAMPA.T(O ?f;.Uti SF
oikkt�+f> 1�.'14t ,10-101 f.)98.00 ; �k
5 FV, W000 �'�iNC , °�t �,fac►1117
E ty%d lhtOGl'It1N`r f 191,-i1W418-000
PLAN r4zff-r lrui: i 111-�y(}i�- Zoe;} 1 H
N' ...: !
M, ,IWe 1 C A 4' Ei 101.ON-421-000 MAC#
..d lai.' I ICAL 1",1{!Y 1.01-000420-000 420-000 $i50.51
LU:MAIM's 4.'H 1,01-000-419-000 $1.3:3.54)
;- Nf11 MoaT1071W t• IFF, -R 1-;tiq n 101 -ono -241,•f) n s! t -114!
a e�6aItdG-;nw 101-040-423-000 $210.00
Nl#n]1i;EJ2eli215-000-43.342 $2,543.62
.
yREICI(E PLAN 191 114"441—M5
ART i'N 9013LIC' Pim ftMS - A-M81I 7014"*, -2 5-(100 $ X9.47
;,1111 1, 00.110SIT 4250.00
f'r fAL C034STRUC,`TTON ANT) PLA14 C1`1"1?CK
$4„27872
LESS :1:'ZtT.;..PAID TEES
4250.00
JUN2 91999 -
y/��Qn pp E' pp' ++ ee��pp.,pp ryry y ��}7•((� '`�{g p� yq
I1,7�].AL:1Ca.ij.6 N f.A%�,�. CIS OU1+1I�iO%1
y`'
$4,0 /9.72
gyp pQ
./I Y Y ®F LA 0U11NT, i
IT N'
RECENT
DATE
By. `J
DATE FINALED
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
5
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
! if/ f- S
Compressor
Insulation
p _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
G
POOLS - SPAS
BLOCKWALL
PPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-r
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ Qq
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) Q ,
ELECTRICAL P ROVALS
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)
�1
Building
Address �(
•"'�"�i'o'4`"ofN"+"'�'?.;�:� -' y� �s:.•� iii'•. sf..i;�:�•,.r++3�.i,+xt`wil�i�tw✓.rr�#'+R'�'+
ul�cu
-o ;��=.
P.O. BOX 1504 APPLI 10 NLY
�11G K 2 LA QUINTA78-495 C_CAL CALIFORNIAFORNIIA 92253.
IT / 6 1
l
Mailing
Address C� fJt X J 1
City .—,
Zip
Tel
Cons.ralctor
off
Address
City Zip— ,,,
Tel. �.
State Lic. G /
& Classif. / J l 1 �(
City
Lic. # 27 I
Arch., Engr.;
Designer
Address
Tel.
CityI Zip I State I
Lic. #
LICENSED CONJ,RACTOR'S DECLARATION \
ffirm that I am licensed and r provisions of Chapter 9 (comma
ision �oMhe 11U yVe!iW , Professions Code, and my license
OWNER -BUILDER DECLARATION
I hereby affifm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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).
I-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 I I, 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 contractors) licensed pursuant to the Contractor's License Law.)
i J 1 am exempt under Sec. B. 8 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. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100; 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: 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 1 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 aliplicant Date
Mailing Address
r City, State, Zip
BUILDING: TYPE•CONST. OCC. GRP.
A.P. Number JJL 1/ , I//r( (` C-? /
Legal Description, (�'�1 f f<.l�y ( / `,L7/t 70 , t eq/r't `"I Z
Project Description�Jl/� L 2 V,)�4 /"t
No.
Stories
No. Dw.--(
Units ..---
New V,-�'Add O Alter O Repair ❑ Demolition ❑
PERMIT AMOUNT
1
Plan Chk. Dep. 250
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances: s' 3
Front Setback from Center Line I'
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line fB.A
.h
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE= FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/29/99
No. 18962
Owner NameCoronel Construction
No. 53-580
City La Quinta
APN # 774-111-027
Jurisdiction La Quinta
Street Avenida Juarez
zip 92253
Permit #
Log #
Study Area
Tract # BLK192 Lot # 20/21 Square Footage 1,830
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
1.93 X 1,830 or $ 3,531.90 the property listed above and'that building,-
or
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be -issued
Fees Paid By ccNIB/Coronel Construction
• Telephone 564-4604,-,
Name on the check 0.
By Dr. Doris Wilson'
Superintendent
Fee collected /exempted by Juanita Green Payment Received $3,531.90
� Check No. 196790
Signature �zI dAdCrIL,
NOTICE: Pursuant of Assbly 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 froffi 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
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
SALE ESCROW INSTRUCTIONS
S%5-av `J f
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY!
TO: COMMONWEALTH LAND TITLE COMPANY Escrow No.: 99.8484KC
72855 Fred Waring Dr. Date: 02/19/99
Suite A5 Page: 1
Palm Desert, CA 92260
(760) 836-3726
Escrow Officer: Kelly Collier
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 .......... $ 20,000:00
TOTAL CONSIDERATION
$ 20.000.00
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 April 5, 1999, and when ORANGE COAST TITLE
COMPANY can issue a Standard Policy of Title Insurance Owners form, with liability of
$20,000.00, on real property in City of LA QUINTA, County of Riverside, State of CALIFORNIA viz:
Commonly known as: APN 77_4_1.1_,027, LA QUINTA, CALIFORNIA 92253
. t,
NORTHERN HALF OF LOT 20 AND ALL OF LOT 21, BLOCK 192 OF SANTA CARMELITA AT,:
VALE LA QUINTA, UNIT 19, AS PER MAP RECORDED IN BOOK 19, PAGES 33-34 OF
MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIAyY.
Except any reservations of record of minerals, oil, gas, water, carbons and hydrocarbons.
Showing title vested in:
CORONEL ENTERPRISES, INC., A CALIFORNIA CORPORATION
Sr .
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 o
record.
.. r
RC District - Plannin4 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
Building & Safety as your correction list. 'Please attach additional explanations as necessary.
APPLICANT: COROMM CONSTRUCTION
- PROJECT -
ADDRESS: e53-580 Avenida Juarez
APN: 774-111-027.
LEGAL: LOT • 20/21, BLOCK 192 , UNIT 19 , S.C. @ V.L.Q.
CK' D BY:' Fred Baker
BIN NO:. CASE NO. 99-58 CHECK DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD
Executive Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM Y
N
COMMENT/CORRECTION I
�•:::`.,\ \n(:��12�\,
\iV:•h.,�•'�``\EP%�
U.:•4�
. .
Fase logged and number assigned
.Verify legal and APN information
owir 0, IT OL V
kV
Pon
Consistent with MDG on file las applicable)
MDG filing required f5+ filings since 9/3/98)
Consistency -with--street/surrounding area:- CASE NO. I
Colors
Materials
Architecture
w"
®�
OTHER REQUIREMENTS:
The zoning code, architectural and landscaping manuals, and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be maintained in the -
Building & Safety address'"file.