0108-256 (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
Date Signature of Contractor v„' t --• ,�
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.
W) I have and will maintain workers' compensation insurance, as required by
Qtion 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.
S 1'ATE FUND 13x0: 4;1".40
(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 .
Code, I shall forthwith comply with those provisions. Jf
Date: `.•�a-;.�: � �: t. • Applicant. 'q- p .a•–
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 underor pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnif
& hold harmless the City of La Quinta, its officers, agents and employee D
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio -
I certify that I have read this application and state that the above information
correct. I agree to comply.with all City, and State laws relating to the buildi '
construction, and hereby authorize representatives of this City to enter up n
the above-mentioned propel y for insp 'etion purposes. r
Signature (Owner/Agent) • -^-'1 t + ' - "'' Date
BUILDING PERMIT PERMIT#
r
DATE S / VALUATION LOT (YJ(*_2M TRACT
$92«6924A) 18 B.1,K 38 M477 -3
JOB SITE
APN
ADDRESS
52.Q70 C ORIEZ
7'13 -202 -WS
OWNER
CONTRACTOR / DESIGNER / EN INEER
COR'Cz)LITE1. INTEIRPRKIrEs
C"CaROMR, r"eAM, RUMOR
FC'DOX 389
fit -150 CAUMITAMPYCO. MSfMN230 `~
Lik'QUI aA C:`,r.'e 922:5:3
7.A{C\��\3:�p7'tib i%. CA.�Y[92!/fib}S3
((�� ( 9
0,60]564-.'{604 E+IA.�.(E�I.. 222,
i
USE OF PERMIT
17114DC�', e'W.Atr!'LAvr, 7'OO7,dVA. tete. DFa.1VWAY APPROACH
11'RAt"-'I' CONSTRUCTION JLas.Q0'6).P
pqPO>yt��"'f�'6yfy3y�pA'1gIO +, Ft3,6.p0�0 �5?
5.trY.'u' 0XIDD MNICE 200.00LF
WaXAM-1) COST CRI C0MIRUCITION
9202.70
PXQS.T A`.R"..!C3+a 6: t4'M.etthatl^c5. ]F
C"aC�?�zx��T TC3v�1I,V WyX�SJ��'�� 1 tp1*.1 ��f3(��Cti-41�?3UC�00
S�R
.�'A.:aF�N ia4�'AfieCK 1` ' P, 101.::C1�FEki""�P;i9-318 �.10 lit;
MEC HAN1.(.`A L, FUE 101-1000.421.000 $53.50
ZLK,' P..1CA1, PT -Z 1011--000-420-000 $U3.56
1''I,:1:fMBING FEE 101.000-419-0(K) $I10.7
;TRCii OW?T;HYS FEE � CESID 101-C 00-241-000 K7.
d:1.RA01140FEW. 101-W-423-000 SWAM
T)ZYW.A:%P9R IMPACTFRE,$3}9U7.00
PUMP. PLAN 101-000-441-345 $100,0€1'
ME a,?EPOSdT 101-0100-439-3118 •'�$��0.4J11
3�
I3k'1:.rw,1ti'C"" .0 rK
$3,441.,.25
,C.1r W 15FX PAID FE1.1ts
4250.00
�.:
g yry.p �p �jyy�� �,g�q q •�.tM a�,�r`p�p
'.7,O•:L.E'A.7.e.X'�Ll+�7L�R�A'S1.87�,�'�.1.�'.�v R.E Oi'Y1MYOF
:�tU
NTA
;
( w By S DA FI INSPECTOR
i ..r. . (� idn r ”
� r .l4. v
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
O.K. to Wrap_
Framing
j� -
%
�I Z�/o7 ` 02
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Insulation.
-' - _
/ �V ` /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
� �-��Z�-
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Water Piping
T
��-3O1 5-
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-Oil S'('
Encapsulation
Gas Piping
Gas Test
Appliances
jG►�
l
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 —G _
Utility Notice (Perm) i� -�
Building
Address
Owner
Mailing
Address p
4ltY (
Contractor
Address
l
City `
State Lic.
& Classif. U L
Arch., Engr., j
Designer
Address
T4tyl 4
P.O. BOX 1504
78-495 CALLE TAMPICO
Z LA QUINTA, CALIFORNIA 92253
ZipTel.
CA S3
ti.. Iw vsti�\
LS 1
Zip _ Tel.
*i -y(("`-1
. -a-,a I_.��.-�
ii City
`1 t Lic. #,�4.
-
Tel.
Zip State
Lic. #
APPLICATION ONLY u
�O o'
u
BUILDING: TYPE-CONST.—OCC. GRP.
—1—
A.P. Number I7 -3,- 3_a — 00 z
Legal Description \.,i Q��E �. Qi U• "
Project Description <___1 • �, t�
..t j , \ C,
lrof affirm that I am license d and ;pro sio s,tSf Chapter with Section'
7 of Divi on.3 of the Business and rot io s (,,ode, and m Ifce,se is In full force and
—fir At R it X ►s— ^`
OWNER -BUILDER DECLARATION n
I hereby affirm that I aln exempt from the Contractor's License Law for the following
reason: (Sec. 703 5,Businq and Professions Code: Any city or county which requires a
permit to construct, er ' "prove, 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 thealleged exemption. Any violation of Section 7031.5 by any applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
l: 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 willhave 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 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 contractor(s) licensed pursuant to the Contractor's License Law.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
r �
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. Compan '
Y `
f7 Copy is filed with the city. ❑Certified copy is hereby furnished.
f
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE I
(This section need not be completed if the permit is for one hundred dollars ($100) valuation)
or less.)
1 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.) l
Lender's Name J
Lender's Address , 11
This is abuilding 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.
i
Signature of applicant Date
Mailing Address
City, State, Zip
(_V,-\ S
Sq. Ft. No. No. Dw.
Size \�"� Stories Units
New IS Add ❑ Alter ❑ Repair ❑ Demolition ❑
ZON r "
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:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
;l.�G" • U
Plan Chk. Bal.
Const.
Mech. /
Electrical f
Plumbing
S.M.I., ^' /.
Grading /i
Drivewaj Enc.
Infrastructure
TOT
I REM S
CR '
"w
IQUIVA
ZON r "
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:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 10/19/01
No. 22597
Owner NameCoronel Enterprises
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 52-070 Street Avenida Corte
City La Quinta
Tract # BLK3 8
Lot # 18
APN # 773-202-005
Jurisdiction La Ouinta
Permit #0108-256
Log #
Zip 92253 Study Area
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
2.05 X 1,485 or $ 3,044.25 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.
r
Fees Paid By CCNalley Independent Bank - Ish Coronel Telephone ;
Name on the check
By Dr. Doris Wilson r
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $3,044.25
Check No. 255686
10TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notity.you that the 90 -day approval period in which you may protest the fees or other payment identified
bove 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 another public entity authorized to
ollect 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
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove
Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety. Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT CORONEL CONSTRUCTION
SITE ADDRESS 52-070 Cortez
APN 773 - 202 - 005 CASE NO.:
LEGAL: LOT 18
CHECK AND APPROVED BY:
BLOCK 38
2001-535
Wally Nesbit
UNIT
DATE:
S.C.@V.L.Q.
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
Verify legal and APN.information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
7
-
("S �c /�`� �P/d�o i• -t � G,
tft �a e
Other Requirements: Q Planning Go=
O City Council
�ecunirnunit
Initials
Case No. &".21
Exhibit
Dot
issio
Dep
3
o
o
�G
VAU
01/01 15:45
c.'1.2001`
REMADING AEQU 5y'
CHICAGO TIT �mOlATO:
AND VM9. d R=
FAX 17608049062
15PM —
COFIONEL ENTB14PRISgS' INC.
P.O. BOX 389
LA auINTA► CA 92283
COMMONifrEALTH TITLE ZERE ! 001
e NO.204 P.
FOPY Ion �>dw
not been c6fnpered with
Tlim SPACE FOR RECOR26522' USE ONLY:
TITLE cRDrrR NO. 017067592
T Dr.6p APN 0773-202-005
ES -.ROW NO. 016P82-1« INDMDUAL GRAN
TOR(B) pECI,ARE(s)
TME UNPERSI('NED GRAN S TAX i6 430.80
DOCUVN6NTAV1Y f� value
f property conveyed► of at time of sale.
tXl oc4'np� _
) cornpLned on full value lers value eft LA WINTAmAND �s r®Tnainln®
� ] 1J4incorporaLed area IX I
City
ceipt 0 f -which Is hereby aGKnowledged►
p:OR A VAI-U�°BLE CONSIDE�AYiON. re .
lSAI,uD M.
oUTIE�� end GWVfA R. GUT1EM�• Huspond andIlUifa ae Joint 7enntr�
hereby GRAtIT16) to:
CORONd EI�iT'ERPEIISES, ING., a Callfornia Corporation described 03:
V of RIVERSIDEr ate of Cat'Ifomia► B 1n pook �$ page
�e rtlftl proife y in the city of .A OuINTA. Goat V Ie La 4ulnte as
%hown� Drop on a
Lot 18. glocok 38, unit Neo So Saf thS m ca R der of ello�/EpsIDE Cou"
69 of 11AW in the � .
com
monly 1,,cnown ss: APN 773-202^006 (Cortez). LA Ou1NTA, CA 93253
r . -.-ft I-%, , _ 2009
psalm of
r-" a (or proved m the on T!{9
ev(d� be t M pefsarl(s) whcaa nAn1e1s1 IeQ
r �yfeatnrl Withy I09Wcnent air d eaWwladvad That
subsgabedauthafted
j) the "4eutad 1110 'lame incl on the
wipmiw1kal, and that by 1deR+sC951:sl9n° the
(��Uf11®nit Zhg "Toon(st, or the mnity upon behalf of which
person(s) acIed, mecutad the InetrumOM•
WITNESS my hand and oHlcisl seal.
Mall W stm1"errm ta'
SALUD M• GUTIEFIRFZ _
&AWR. GUfIERREZ
(11O emu tar off{Clel notarial Seep
Feb. 5. 2002 1:17PM
No•9953 P - 2
'CITY;O?A QU{NTA
UYLbIt&�r SAFETY DEPARTMENT
-7012
j IpN REQUEST LINE
777-7153
Owner CORONEL ENTERPRISES
Contractor CQ$p11CF L C�►NSTItILC lCai
Permit Number 0108-256
POST ON JOB IN- CONSPICUOUS PLACE
INSPECTOR MUST SIGN- ALL APPLICABLE SPACES
JOB ADDRESS 52-070 AV•ENI DA CORTEZ
SFD - LOT 18 MSTER- Z]BK 1485, PERMIT DO)~S NOT
INCLt1DF ]BLOCK WALLS, POOIJSPA OR DRIVEWAY
APPROACH
TYPE -OF INSPECTION DATE INSP.
FOUNDATION & SETBACK // * — S,;;,
MAIN GROUND SYSTEM
GROUND PLUMBING 9
PRE-GUNITE
DO NOT.POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE$LAS
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST ff �
HEATING & VENT • A/C
FIREPLACE
BOND BEAM
O.K. TO WRAP
GROUT O 4' ❑ 8'
FRAMING �J
INSULATION C5,L?,
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR Ce -
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
1 I
FINALS
EL
FINAL GAS TEST
HEATING -AJC
HOUSE NUMBERS
JOB COMPLETED -
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO ._
TURN ON HT" ITrco nr+ - -
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 ADDRESS:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
52-070 AVENIDA CORTEZ
Bldg. Permit No.: 0108-256
R-3, U-1 Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL ENTERPRISES
Building Official
Address: PO BOX 389
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: FEBRUARY.5, 2002
POST IN A CONSPICUOUS PLACE