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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
� 111A6 &18 i
VDatl Signature of Contractor
OWNER -BUILDER DECLARATION
U11100
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 requyed 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.
(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
¢ode, I, shall forthwith comply with-those;provfsions.
,Date: / / It ZdApplicant
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 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 insPection-pur•p,�osses.
Signature (Owner/Agent) � --" Date
,t v
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT'h TRACT
,
e
ADDRESSJOB SITE 3-3~�1w1,f,V�J:.,3 IDA�l[�VAKRO APN 774-094-417
OWNER CONTRACTOR/DESIGNER/ENGINEER
t't,) 3f�iu/r, x'4 J�Iyi'I t;f
7101N, Cc;it ONE.i, t`ONIIII1110'i:
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APP OVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
,s /�
Exhaust Fans
O.K to Wrap _ _
_
F.A.U.
Framing_
Compressor
Insulation
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
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 APP OVALS
Gas Test
Waste Lines
_
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection9
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring , '
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
L
Final
Utility Notice (Perm)9.�
�.r ^!. ti. 4•-,'•,..r�W.t- y R .�s : �. rt!" �^�: r'r'.N. ^+. r�. Yr t.. •:l '�;r ....a.+... t-,f-'�,r . r
57
TA
4
P.O. BOX 1504
Building 78-495 CALLE TAMPICO APPLICATION ONLY
Address s - 3 �Ga Q//Q ! / LA QUINTA, CALIFORNIA 92253 '
Owner CORONEL CONSTRUCTION
Mailing P.O. 13OX 3119 BUILDING: TYPE'C-O-7NST..J OOCC. GRP.
Address ,92253 A.P. Number
City ' Legal Description_ Zip Tel. �;'f' �, 1]I �. 0•�7 LI
A,'1 Z0
►
ContractoWRONEL CONSTRUCTION Project Description A
ress F-,%" a- ---
LA QUINTA, CA 92253
Zip I Tel.
State Lic. City
& Classif. 3Lic. # 2 Z G
Arch., Engr.,
Designer
Address Tel
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyyaffl mm 'that licensed under provisions of Chapter 9 (commencin withrSection
70W)).of'Division 3 of the Business an lotessions Code, and my license is I full orce
.. �;1 yam'
SIGNATURE
OWNER -BUILDER DECLARATION
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 to construct, alter, Improve, demolish, or repair any structure, prior to *its Issuance also
requires the applicant for such permit to rile 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).
1' I, as owner of the property, or my employees with wages as their sole compensation, will
d0 the work,,and the structure is not intended Or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Caw 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.)
('1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a confracfo/(s) licensed pursuant to the Contractor's License Law.)
i i I' am exam - untiee rSecc.. ' 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 '1
r] 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 lhp 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 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
size Ft. L/
Size -I
New &r. Add ❑
No. No. Dw.
Stories % Units
Alter ❑ Repair ❑ 'MrDemolition ❑
Estimated valuation
PERMIT AMOUNT
Plan Chk. Dep. V-2rnn �•,
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from enter Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Froperty Line
FINAL DATE INSPECTOR t
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK= BUILDING DIVISON
Desert Sands Unified School District ,
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/1/98 APN # 774-094-017 '
No. 16836 Jurisdiction La Quinta
Owner NameCoronel Construction Permit #
No. 53-365 Street Avenida Navarro Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1421
Type of Development Single Fam11y 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 to4he following
reason: ° r
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 project may now be issud� tt
c v
Fees Paid By Cashier Check/Coronel Construction-Telephone564-4604
.w.
Name on the check
By Dr. Doris Wilson '' 4
Superintendent'`
Fee collected /exempted by Juanita Green Payment Received $2,742.53'
Check No. 158279
Signature
NOTICE: Pursuant of Ass bly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protes- 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 —iother 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 wai-ers.
i-
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
'DOCUMENT
SALE ESCROW INSTRUCTIONS
44
WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY.,
LAND TITLE COMPANY. -7304KC_---'1.
Escrow No.: 98.,
�FAJ,4,
*0
2855,wFre`d Waring"!Dr. Date: 03/.03/98, r
. I S J. e "A5
Page: 1
P a m,-- , Desert, 'I" --- D 't CA,92260
_-%4;VV'J ;U067019r,
411
I y LU I I
4q'uwiU,1A 1L;0!! U,
-till -IOLDER IS COMMONWEAL'I'l-I LANI)'FFFLE COMPANY WHICH IS
411ESCROW I
BYZILE, CALIFORNIA DEPARTMENT OF INSURANCE.
.,
-x.
Buye r will hand you additional funds prior to closing in the amount of .......... $MINIMlik'r�"'
-Proceeds from loan to be procured by Buyer (First Trust Deed) ................... $F1HA!,MAX,'
nv
7-74 01 -7
3.
5.3-13GS' KAV'ARZ0
sJTOTAL:4',. CONS I DERATI ON
W;any,�,iidditional funds arid instruments h`
ri)nts required from me to enable you comply W' l.t. fA
h 'li.
*�frbctions-, which you are to use on or before June 10, 1998, and An OLD REPU LIUA156V
.COMPANY can issue a Standard Policy of Title Insurance Owners form, wi& liability !off'-`,�.
on -real property in City of LA QUINTA, County of Riverside,: State of CALIFORNIA
iv,, I Z.-
4
atofih6n],y',_inown as:.AVENI'DA NAVARRO,*LA QUINTA,
CALIFORNIA
10T�.�6`'IN,':BLOCK 214 OF -SANTA CARMELITA AT VALE
LA QUINTA, UNIT NO.20, AS PER MAP
V -
BOOK 19, PAGE 38 OF MAPS, RECORDS
OF RIVERSIDE COUNTY, CALIFORNIA
�REQQRDED;.-IN
Except;any4eservations of record of minerals,
oil, gas, water, carbons and hydrocarbc
kt , -t-Tb,�vested in:
pw 41ii g1II
F, 111Vl
IJOHNSON, -
'RAQUEY'WOHNSO Wand FRANCES
LT;p if r om e n'c umb r a n c e except:
I
I
iTrent general and special taxes for the fiscal year in which this escrow 0bses�,$`a_n_d
xes"for the ensuing year, if any. a lien not yet due or payable.
ltl�)'ien of supplemental taxes, if any, assessed pursuant to the ,provisions ofjCh-apteF
1, ex
5, (commencing with Section 75) of the Revenue and Taxation Code of the State of
lifornia.
J, if any. kf,a 1 improvement assessments, Y.
2AN
sements, rights, rights of way,'covenants, conditions, restrictions an& reservations
7 V
`
iidof Trust to record in the amount of FHA MAX, in favor of a lender to. be6eter
..,' mibe(
Mal
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