9612-106 (SFD)LICENSED CONTRACTOR DECLARATION
A,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
Dat?' ` 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).
( ) 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.
GiWfl DEIR A RtZLE ,rYNs. tv' V�'Ci42 $�2t
(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 tombecome subject. to the
workers' compensation laws of California, and agree, that if I, should become
r
sub'ect to the workers' compens�if'67 provision hof Section 3700 of the Labor
d I sli II forthyvith comply wifh those provisions.
Applicant
Warning: Failure to secure Work rs' 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 180 days will subject permit to cancellatio�ji. l 1T
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and St ieilaws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the bove-mentioned property�for inspectioh purpol es.
-10 ignature (Owner/Agent)/r c Date
PERMIT # CONTROL #
BUILDING PERMIT
9612-106 4699
DATEVALUATION S!)2t692_70 LOT TRACT
'OBITE
ADDRESS 54-405AVENIDPA c��.i..ARE7.
APN :774432-019
G ER
CONTRACTOR/DESIGNER/ENGINEER
EISM-1(pil ~f,.• r'#,"?dZC3xva,
C;'ORONE1., C'fJNS`i`i':ClCI.'. ON
P.O. BOX 389?51540
IHA 2'[JiiOWER UR
i, 1. WNTA SLA. 92253
I.A. QUINTA. C;r1 92253 -
(6119)564-4604 f::AL-0 2261
USE OF PERMIT
9FD 4ERWT. 1t.�1f S IY61C rf�r>i. LMR, ril�OC WKILL okPoM BUT DOEis
%r"'�.,3`�'.� ��`w+�S"i.`iZI3►:'t'!Q� 1.,'li�s`+.t10 %I'
X00 sc;
t_.t1I+t.J•iOIIQ;Jt►RfOORT 5t.t30 SF
6 F 7`. '41000 `F"FNC.6 J.(T0 %,F
MIlNIATEi13COST OF CONST'Ri1CIION
9, 102.70
-
101-000-4118-M) nriyepnt
'Cal,'rl7�fC �e".2GRX, I.()�-OC1f1�43°-31€3 $509,86
MCCHMOCAL r.1% _ 101:409-421-000 $53.50
EIdWMICAL FE13. 161 -OW -4204-K) S125.56
y
tar.d7 m, mm 10.1-000-419.000 $l27.St)
s ON4s'�: D'ir3j 1*.. t aSl.l I 101'000-241-000
ORMYN01 mi -i 101=000-4.23.000 $ !ate
im-RAsiWicruRn FEE 225 -00-443-342. s4axso
PRECIS P A:N �'101-0W-441.345 � •6�"+
PAI® sR
FEB 11 1997suwr6�A , COMM'IM110'N"AND PUN 0113CK
LESS 71'Rz:-1?AID FTS
4250.00....
Qu'1OA
LA.VER NOW
®F T(XiA,.PtIRAW 01%
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
whacks
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Combustion Air
Roof Deck
S — 3 - Cf
Exhaust Fans
O.K to Wrap
r7 A0
F.A.U.
Framing
- 154Compressor
Insulation
— /-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Pa ire
erior Lath
Drywall - Int. Lath
Final
F' al
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
I
Electric Bond
Footings
2 4 7 Z OT
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
Show
O.K. for Finish Plaster
ewer Lateral
Pool Cover
Sewer Connection
Encapsulation
as Test
liances
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
f
�t"wl/01I1994 18:07 6195644202 CORONEL CONSTRUCTION PAGE 04
ITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
�°�1 7-7012
Owow
G� 1 NA CTION REQUEST LINE
F�01
7-71S3
UIEL CORONEL
Cont CORONEL CONSTRUCTION
PwM Nu"dw X612-106
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
Joe ADDRESS 54-405 AVENIDA JUAREZ
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALL OR POOL BUT DOES INCLUDE 200
rfK OF INSPEC"M DATE INSP.
FOUNDATION a SETBACK
I
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAd BEEN SKNEC
CONCRETE SLAB _ )
J016M A OWMERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRET9 UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
a VENT -
PR
�`1�.--.lac`' {�(:C.—�/ll%''' •l'; l''
COVER NO WORK, UNTIL AsovE. A 9EEN SIGNED
PRE PLIC'
FENCE a
R SEPTIC
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/06 TURN ON UTILITIES OR OCCUPY BUILDING
Building
Address J
Owner �!
f!
P.O. BOX 1504 APPLICATION ONLY
p 78-105 CALLE ESTADO
I%G - <l Uglei Z LA QUINTA, CALIFORNIA 92253
mailing n
Address ! 1' o X 3061
City "f Zip l T
el.
Contractor
. Address
City 5p Zip Tel..
State Lic.��] City
& Classif. 34ell Lic. #
Arch., Engr.,-
Designer
BUILDING: TYPE CONST.• OCC. GRP.
A.P. Number--) .- d 3
Legal Description
Project Description
Sq. Ft. f No.
Size. /-1�.� . Stories
Add ❑ Alter ❑
No. Dw.
Units
Repair ❑
Demolition ❑
Address
Tel.
Minimum Setback
Distances:
Front Setback from Center Line
City
Zip
State
Side Street Setback from Center Line
Lic. #
LICENSED CONTRACTOR'S DECLARATION
INSPECTOR
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
Date Permit
effect.
SIGNATURE - DATE
Validation:
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
. reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit toalter, improve, demolish, or repair any structure, prior to its issuance also
thconstruct,
requires e applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT AMOUNT
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
Plan Chk. Dep. Q.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
t7 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
Const.
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,
Mech.
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
Electrical
of proving that he did not build or improve for the purpose of sale.) '
['l 1, asowner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
1*7 I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
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
❑ Copy is filed with the city. ❑ 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
1 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 if 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 DIVISION
Infrastructure
n
ri r
V q
TOTAL
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:
Validation:
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES'•
1ST FL. SO. FT. g $
2ND FL. SO. FT. try
POR. SO. FT. Cry
GAR. SO. FT. @
CARP. SD. FT.
WALL SO. FT. @
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
i
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1'A c
SEWAGE DISPOSAL
SO.FT.GAR @ 14c
HOUSE SEWER
REMARKS:
VENTILATION
GASPIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB, FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
i
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
A' -C. Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 2/11/97
APN # 774-232-018
No. 15258 Jurisdiction La Quinta
Owner NameEsequiel Coronel
No. 54-405 Street Avendia Juarez
City La Quinta
Tract # Lot #
Permit #
Log # 9612-106
zip 92270 Study Area 110
Square Footage 1485
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
1.84 X 1,485 or $ 2,732.40 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 Esequiel Coronel Telephone
Name on the check = ,;
inn
By Dr. Carol McGrew
Administrator in Charge ' %, „ .S
Fee collected /exempted by Julie O'Neil YPayment Received��.` r` -
tfX.
Check No. 133157
Signature .,N
NOTICE: Pursuant of ss mbly 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 fr m 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 i ict('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
JAMES o. WAUACE
Avitcullutol Cotm,t.dol,nt
Dhecloi of W910111S a Mvoruing
orrlcr or 1I IE
AGPICUL1URAL COMMISSIONER
P.O. BOX 1009
I11VI:I SIDI; CA 92502-1009
PI 10HE (9(r) 7.75-3000
rnx (9(n) 276-3U 12
CALVIN c. ICAMINSk
s Aitblani Cornrninion
DAN MLEY
Sootor, W0101116 A Moo
' 0'7)116.9010
rnx (907) 276-4726
133-612 Ave1111e A'J SUlLe
111(110, CA 92200
(619)063-029.t
AT_..-_ c.'As►.; NO. Cy 12 A
,t
ADDRUSS : ,
•1'I;IA-111 IUNC :
Uea.r Uevejupet-:
After .rev iewillg, your' 1011(Iscilph1g I�ll(tls, all I�la111 mater. lr�l l l.9ted is 'rlvt in
vlolatloll or (lua(.011t,i11e lawn governing, Lhe c0achella Valley. If • substitutions
do occur 311(1 they differ from planL material l fisted, this office must be
notified innnedIaLely.
a
1 •
I'11ank you for hroLecLing and hreservlllg Lhe Coachella Valley's pest -free
envirolnnenl . .
i -
Agricu ural Connnlss1o11ett.'s UfCice
cc! 111(lio "nd Iilverside
:I
1 ,1• .
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