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0104-298 (SFD)i 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: Date 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: ( )A �I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot 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). c . (,) 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: Cartier 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 th3 •cork 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 l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply'with those provisions. Date:_ ` Applicant''• Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, 06icy addition to the cost of compensation, damages as provided for in Section 37 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject .to the .conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as i result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the -building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. .Sigriat'ure (Owner/Agent) Date BUILDING -PERMIT PERMIT# DATE VALUATIONLOT 0104-2,08 TRACT ' 17 JOB SITE�rtwy� ADDRESS APN 7i�-335 CAT.: X ILOILO 770-164-01.6 OWNER CONTRACTOR / DESIGNER / ENGINEER C!O?ROM , CONS"1;.id.UCtl�..�i' IR ti:tJiZC)ARL C:U%OMU'C11014 78.150 CAUXINMY[co a3C3r-M$.230 7 8.15 0 CAI.Lft;.T.r'• WIC -0 INU317#230 LA td7 fl1 (TA M 92253 LA QL15ITA C:'.A. 92253 (W-0)564-4604 C. ul 7,7,61 USE OF PERMIT 4'.1-1.+PA).1.\.MI DOZE NCYT MC1,11,101 ,., BLOCK IVA12DRIVIKWAY APPRi%riCi,I,Y OR k' X1101 MA.3'17ER -1 "%:4aDF °1,RAC T i'.isNa1'11.Usb"t'iOA,f t;4 i.tii+ Err i� pilCl ldi� i`I a6.fi0 SIV, 3 Vt.'t1dOOD FMC111 2ii0.1tq 3,F GAP,A.GP ' F 0. fzr S1` ''XIM"i�3.,f rKID C-:+ 511 OF C,'-C�.I�S"SR�Tf:',�MN ��yy'��,:; yp��.. rr�� nn�} �, }y pig ,�' p��g ITT, DE!"Q- 11' 10 l -000-3,39-24) a 41MAM C3 aNSTRUC x SON 714,x. 101 -WO -418-000 $504,$0 P1.,r' OC DZCKi�''N, 101-000.439.338 139032 ;.IfClil 11C�AIW ,ijlat? 10 i x000-421 -000 $60.0 P,3.W,TP0, ME, 101.Oi} -IOW,420-000 $129.44 G.EbM1NKY119 11,01-000419-000 1). 0. 7 g$.�SSR�ysOTIRIT,V1Lp0°Cy-7401 .wRADINO1+ US '101-f 00-423-000 $2010A 7Y'LSYY.'A /!h II6�YA 1 "�i.R P�1T ii2 Q' Q nn 1BSYY i:w.Yl+✓.r PRECYIISM,1 1 MA,iJflOR.-` ou - -'1°U' 't . coAr��Q�'C�m :' .1 o v!Lw +(:i�pF.�x- $1,430.74 ° 7'1. •1.5 3rSEN 42's13°CO CITY FINAhiflo B rIM0141r..IIFINMrAl NOW 13,180,74 RECEIPT DATE/� BY DATE FINALED INSPECTOR f INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS.. Set Backs _ Forms & Footings Slab Grade l �+ Steel Roof Deck • 3 -� s� O.K. to Wrap �. p— 01 % Framing Z; 19 r Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall FirewallExterior ath Drywall Lint. Lath Final o / 7/ BLOCKWALL APPROVALS Set Backs Footings Bond Beam PLUMBING Waste Lines Water Piping Plumbing Top Out Shower Pans Sewer Lateral Sewer Connection Gas Piping Gas Test - e ALS Notice (Gas) ELECTRICAL APPROVALS Power Pole ground Conduit Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Gas Piping Gas Test Electric Final Heater Final Plumbing Final Equipment Enclosure O.K. for Finish Piaster Pool Cover Final COMMENTS: POOLS - SPAS C .FA O I V Building Address .-L-- Owner C_nt ei„ 1 c-- �..� t 4 I . " P.O. BOX 1504 78-495 CALLE TAMPICO -� LA QUINTA, CALIFORNIA 92253 Mailing r Address C) City Zip Tel. Contractor l__ C State Lic.City / & Classif. < 1\, q c `42, " Lic. # /tel Arch., Engr., Designer Address Tel. City Zip State "11-1 . Lic. # LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed ynrfei Drov Bions of Chapter 9 (common ing,.wit, 7000)'df Divis 6n 3 of th ��using�'s�$n_d Profs Code,,.agd�.+Lny license lh�fLll f effect. / s /OWNER•BUILDER DECLARATION I hereby sill ym t��at'l am exempt from the Contractor's License Law for the following reason: (Sec. 703'i.5,Busind"ss 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 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 17: 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 of 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.) 1'1 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business -and Professions -^ode: 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 ConUactor's License Law.) 1-1 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 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 (8100) 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 if work thereunder is suspended for 180 days. I certify that I have read this application and slate 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 ateMailing Address ,City, State, Zip APPLICATION ONLY BUILDING: TY-P^aE'CONST. 1 OCC. GRP. \ A.P. Number 1 -10 - �� - U N t, Legal Description `--c�'t " VA ki (A t� Project Description M r. A TI ('\ N I r� i ZONE: BY: i Minimum Setback Distances: �, y 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: + i '�""' WHITE -='FINANCE YELLOW =APPLICANT PINK=BUILDING DIVISION Sq. Ft. Size No. ` Stories \ No. Dw. Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation AMOUNT Plan Chk. Dep. Plan`i3hk--B6l "' Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 4 w y p TOTAL REMARKS i ZONE: BY: i Minimum Setback Distances: �, y 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: + i '�""' WHITE -='FINANCE YELLOW =APPLICANT PINK=BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document,Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 5/7/01 No. 21977 Owner NameCoronel Construction No. 51-335 Street Calle Iloilo city La Quinta Tract # Lot # Type of Development Single Family Residence Comments APN# 770-164-016 Jurisdiction La Quinta Permit # 0104-298 Log # zip 92253 Study Area Square Footage 1,421 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 2.05 X 1,421 or $ 2,913.05 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 CC/ Valley Independent Bank - Ismael Coronel Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Paula Ruiz Signature Payment Received Check No Telephone: 7,00'5 64-4604 $2,91%3:05 244547 NOTICE: Pursuant of Assembly Bill 3061 (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 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 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 I F_ 78-495 CALLE TAMPICO LA QUINTA, CA 92253 - (760) 777-7075 APPLICATION I Vq ,a fa -p.µ - FLOOD PLAIN DEVELOPMENT PERMIT BUILDING SITE LOCATION FLOOD ZONE "AO"- DEPTH 1 COMMUNITY- PANEL NUMBER 060709 0 B Map 8/1 Revised: 8/19/1991 APPLICANT INFORMATION SECTION APPLICANT NAME, APPLICANT ADDRESS I. U.Oox r .. �,i,•—\•./. U\1ZZ S3 (MAILING ADDRESS, NOT THE BUILDING SITE) DAYTIME TELEPHONE NO. INSTRUCTIONS 1. A Flood Plain Development Permit is required by LQMC Section 8.11.040(A). The Applicant should complete the Applicant Information portion of this application and submit it to the Engineering Department along with the required documentation noted hereon at the same time the Precise Grading Plan is submitted to the Building and Safety Department for plan checking. 2. Documentation required for STEP 1 OF 2 APPROVAL prior to receiving clearance for Building Permit issuance • Copy of the proposed Precise Grading Plan for review and approval containing all information required by the checklist shown on the back of this application. 3. Documentation required for STEP 2 OF 2 APPROVAL prior to receiving Flood Plain Development Permit approval. Note, this approval occurs after forms for the lowest habitable floor are set and before the Building & Safety Department authorizes foundation construction. • Submit a completed FEMA "Elevation Certificate" form to the Engineering Department. • Submit 95% relative density soils compaction certification to the Engineering Department. STEP 1 OF 2 APPROVAL STEP 2 OF 2 APPROVAL The Precise Grading Plan submitted for this application has been All requirements have been satisfied. This Flood Plain reviewed and found to contain all data required to satisfy the Development Permit is approved. requirements of LQMC 8.11 The proposed dwelling is eligible to receive a building permit upon satisfying all other Building & Safety Department requirements. U/d Wr 12 Yl�o� UTHORIZED SIGNAT45REr DATE AUTHORIZED SIGNATURE DATE La Quinta Engineering Departme La Quinta Engineering Department FILE: Upon Step 2 approval, original goes in "Flood Plain Development Permit" file; copy goes to Applicant F090 REV -2 7/00 r CHECKLIST FOR PRECISE GRADING PLANS IN "AO" FLOOD ZONE 1. Prepare Precise Grading Plan in accordance with Checklist for Precise Plans and the following additional items. 2. All elevations shall employ the NGVD-29 convention. 3. Show and label elevation of "Highest.Adjacent Grade" next to the building footprint. This refers to the highest. existing natural grade next to the proposed building prior to constructing the elevated the building pad. 4. Show and label the "Highest Existing Elevation 'on Lot" 5. Show and label the "Lowest Habitable Finished Floor Elevation". Note,. this elevation shall be at least ONE FOOT higher than the "Highest Adjacent Grade" elevation. . 6. The following grading note shall appear on the plan: All fill material placed under the structure shall be compacted to ninety-five percent (95%) relative density. F090A 10/88 Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding 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: SFD Occupancy Group: R 3 51-335 CALLE ILOILO Type of Construction: Owner of Building:. CORONEL CONSTRUCTION Building Official Bldg. Permit No.: 0104-298 VN Land Use Zone: RM Address: 78-150 CALLE TAMPICO #230 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 08-16-01 t POST IN A CONSPICUOUS PLACE