9712-132 (SFD)Im—
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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
131118.
ate Signature of Contractor l - % / 1 •" s --•'
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).
( ) L, 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.
GOLDEN F.AGLE INS, NWC'A2189200
(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'ths 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 provpfons of Section 3700 of the Labor
C9d`e, i hha06irthWjh comply with,t6s prov�slons.
ate: �- 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 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 authize, representatives of this City to enter upon
the above-mentioned propeiiyAor ins `ection purposes
Signature (Owner/Agent)fs` J'Date
BUILDING PERMIT PERMIT# CONTROL# -
a1
DATE VALUATION LOT 97112-132 TRACT 6535
�92,611.2.9(i _
JOB SITE
APN
ADDRESS 53-580 AVE NIDA CORTFZ
OWNER
CONTRACTOR /'DESIGNER) ENGINEER
ESEQUIEL M CORONEL
CORONEL CONSTRUCTION
PO BOX 399
P.O. BOX, 9
LA Q IINTA CA 92243
LA QUINTA CA 92.253
(76q)5644604 C;'BL# .226.1
f'
USE OF PERMIT
7
n
rt
3FD '• JYMUT Df?E•S NOT INr'.LLU1r ALOc.X WA1.LS�OR. PO 4—
JAN
16 1998
TRAC" r CONSTRUCTION 1,485.00 SF
PORC.HiPATiO 30.00 SF
C' 1AR.ACF:'CARPORT S()7.00 SF ()'TyO
Lim 0 U1NTA
6 FT. WOOD FM -ICF 200.001F
ESTIMATED COST OF CONSTRUCTION
92,682.90
PERMIT VEE SUMMARY
CONSTRUCTION FEE 101 _100 -•I18 -(1t10 SGOl3.utt
PLAN CHECK FLEE 101-000-439-318 $iI t.36
NIECHANICAL FEE 101-000-421-000
ELECTRICAL FEE 101-000-420-000 $1.25.56
PLUMBING FEE 101-000.419-000 E 122.50
STROI-40WTION FEE - RESM 101-000-241-000 59.26
ORADING FEB 101-{lti[ 423-000 $2u.4o
INFR.ASTRUCtUR6 FEE 2254)00-44.3-342
PRECIS'F PLAN 101.000-441-345
FEE DEPOSIT -$256.00
SUB -TOTAL, CONSTRUCTION -IM PLAN CHECK
$3,516.74
LESS PRE -PA 1D FlES
TOTAL PERMIT FE05 DUE, NOW
$3,266.74
RECEIPT
DATE
BY (!
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings I I
Ducts
Slab Grade A 11
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing T
Compressor
Insulation
Vents
Fireplace P.L. f
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
®LOCKWALL APPROV S
POOLS a SPAS
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
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
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
Final
Utility Notice (Perm)
COMMENTS:
Certificate.,of Occupancy
City* of La Quinta
Building and Safety Department-
This
Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, *at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use.. For the following.-
BUILDING
ollowing:
BUILDING ADDRESS: 53-580 AVENIDA CORTEZ
Use Classification:- SINGLE FAMILY DWELLING Bldg. Permit No.: 9712-132
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: ESEQUIEL M. CORONEL Address: PO BOX 389
City: LA O,UINTA, CA.; 92253
%1 By: DANIEL P. CRAWFORD JR.
Date: 7/11/98
Building Official
POST IN A CONSPICUOUS PLACE
P:O. BOX 1504
BuildingS3 _ 7&105 CALLE ESTADO
Address 8 G ✓ r- Z LA OUINTA, CALIFORNIA 92253
Owner / ,� /
CityJZip Tel
State Lic.; Cty
& Classif. �: � Lr �' 1 JL�Ii#c: 7' 7 6.1
Arch., Engr.,
Designer
Address --- -I jei.
CityI Zip I State
Lic. #
LICENSED CONTRACTOWS_.DECLARATION'
I hereb affirm_that I am licensed under previsions of Chapter 9 (commencing with Section
7000) of 184166 on 3 .1 the Business and Professions Code, and my Homm�ls ir( full forma
effect. e, / / /
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason; (Sec. 7031.5.Susiness and Professions Cade: Any city or county whAdh requires .a
.permit to construct, atter; Improve, demolish; or repair any structure, prior to ft:Issuance also
requires the .epplicanr for such permit to file a signed statement that he Is licensedpursuant to
the provisions of the Contractor's. License Law, Chapter 9 (commencing with .Section 7000) of
O/vision 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 notmore than five.,hundred dollars ($600).
17 I, as owner of the property, ovmy 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. N, howevei„ the building
or, improvement is, sold within .one year of cor**16n, the owner -builder will have the burden
of,proving that �he did not build or improve for the purpose of sale.)
C1 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
doesnot apply to an owner of property who builds or Improves thereon, .and who contracts for
such. projects with a coritractor(s)'licensed pursuaht'fo the Contractor's License Law.) -
17 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, nsurance, or'a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ 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 -s0 as _o become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: I/, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must bhhwlth
cbmply with such provisions or this permit shay 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. 3087, Civil Codej
Lender's Name
Lender's Address
This is a building permit when property filled out, signed and validated, and is.subject to
expiration if woik 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 relstinq to building
constructloni 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
APPLICATION ONLY
IILDING: TYPE CONST. OCC. GRP.
P. Number -7 7 Ll — /0z- -- GOA/—
:gal Description L f 277,
oJect Description -S
size t
New 9--` Add ❑
No. No. Dvir.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc,
Infrastructure
TOTAL
REMARKS
ZONE: BY: `
Minimum Setback Distances:
k from Cdnter Line
eJAfrom Rear Prop. Line
Side Street' Setback from, Center Line
Side,Se bt 6m Property Line
FINAL DATE INSPECTOR
OF Issued by: OF I = Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO, PLUMBING FEES
IST FL SO. FT. a §
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. Q
FORMS
SEWER OR SEPTIC TANK
POR. SQ. FT. Cr
MOSILEHOME SVC.
BAR SINK
GAR. SO. FT. a
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP./EQUIP.
DRAINAGE PIPING
CAR P. SO. FT. @
TEMP. POLE
WALL SO. FT. 0
GROUT
DRINKIN.G.FOUNTAIN
SO. FT, @
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION E
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENTSYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)IDISH)
APPLIANCE DRYER'
GARBAGE. DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T,U,
SO. FT. c
BATH TUB
GAR. FIREWALL
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, S.T.U.
SO. FT. RESID Qi 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR a 3..4c
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
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.
FENCE FINAL
INSPECTOR'S SIGNATURESflNIT1AL5
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 1/14/98
No. 16510
Owner Name Esequiel M. Coronel
,� 175J5�
APN # 774-102-004
Jurisdiction La Quinta
Permit #
No. 53-580 Street Avenida Cortez
City Palm Desert zip 92253.
Tract.# Lot # Square Footage
Type of Development Single Family Residence
Comments
Log #
Study Area
1485
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
1.84 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 ccNalley Independent Bank/Coronel Enterprises
Name on thetheck
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline. Pearson
Signature QwJ_A_b_AA� D,061.lubml
Telephone
j Y .
Payment Received $2,732.40
Check No. 158019
40TICE: Pursuant otAssembly Bill 3081 •(CHAP'549, STATS: 1998) this will serve to notify you that the 90 -day approval pertodip whieh,you may protest the fees or other payment identified'
ibcve.will'.begin to run from the date on which the•building or installation permit for this projectis sesued or on which they are paid to the District(s) or to another public entity authorized to
)ollect them.on the District('s)(s') behaM; 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