9700-009 (SFD)LICENSED CONTRACTOR DECLARATION
U) 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
N W Professionals Code, and my License is in full,force and effect.
O Z) M License # Lic. Class Exp. Date
W
Z r, /Date r✓' ` + Signature of Contractor0�s
CD U rn OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ 41 License Law for the following reason:
Z_ ( ) 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).
ce) () I am exempt under Section , B&P.C. for this reason
LO
nl Date Signature of Owner
ON
0)
LD Q WORKER'S COMPENSATION DECLARATION
o 2 Z I hereby affirm under penalty of perjury one of the following declarations:
1,2 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
E0 Q U ('j) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? z Carrier FT 1 t� Policy No.
ob iia °L3�I`7of l,fi� i,la i�� i, cv +`4'19*tr)1) `VtJ
(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
3 subject to the workers' compensation provisions.`of Section 3700 of the tabor
Code, I shall forthwith comply`with those provisions.
1/6ate: = r % Applicant 4 4y
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each personat ,
whose request and for whose benefit work is performed under or pursuan66
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and6State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for insp� ion purposes. t:
rSignature (Owner/Agent) �� �� /d Date/`
BUILDING PERMIT PERMIeI�aW� CONTROL#
1 3 8
DATE n� VALUATION ea LOT TRACT
(/d 7 h �. �. , , ,
ADDRESS v �' t�� i 1�I��LC Pi .il� �i�1r1 .� JOB
APN 777, Y'}1. 6101N
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IS ISI.' EL B t:°>" )%,01 Sh;1,
3i ►aii livl, h°° dlSa'►Y�'I°i� .DR
LA Q1116V`V N. (.'A O.IYV1
I mA 01 II�rCIN, CA 4 253
11,49),W-4404 MAI 1117161
USE OF PERMIT
SF0 - P11 -kA ll Lr'K1RS tN04 INCrA0011 t3LK;fi k WA1:I.v t* P� j,. rpt_,L01)Ls*i
1411)1"K, 6' WOOD F1'ih't'E
(JAR A(ItY 'ARYL &V' +.t .( 1 83
rNTIAIA`F ,D CONTOr CONS RUCHO+'d
OR;6 01< SONIMAai'
C0'N8TX11(7rI0NFIF F to$
1.J1_A1q CIO -4'K FRI 10 14100-1311 if 8
ter.°t,tfAt�Ie�Ahl I �; Iui<Oilth�i�I-440 �ti3 tia
14,Vf 7RICA11, 1 EFF 101 (M-40)0 SSi Ifkli I"
14,1 I,NIIIATKfi 04- 1101 Pplt1h 1114-(11}1) gl I� 75
`a I' %%�vtiC�G�.SII Citi1'r'I "tt?`�IIJ 101 (Wi�")'74IVO �3
f'r tFil)l�i I•t I.CIltdt
Ib1PRAN11V1f�'i' ;XA'-'F'hi' ?211* lft _4-13-34u " ttil,s" 117
PtiJ, (T4F M N � i AI �(Jt!(? �I,�1 _,�h ��R tit)
NOJ�i-I'l'►'�!(dt'C> J "I}iC3L"�`iC`a t Ai>I1_) At,A t"�li�t�
0�111009w
IX,%., ld?-I'AI1 1, 1,"
0 51997
SUN 'I'M At. P�,, Wff IF FM Darr, N()VIf
Cf
RECEIPT
DATE
ABV;
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
ZSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVA
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
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
BLOCKWAI.X
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
z
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
COMMENTS:
Final ev
Utility Notice (Gas)
ELECTRICA PPROVALS
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)
T4 4 4 Q
ulk& T704 -- 001.
P.O. BOX 1504 APPLICATION ONLY
Building ' /�U /J_ _ _ / / /G S�v 78-105 CALLS CALIFORNIAESTAD9
Address J` /N�' (-/P ( LA QUINTA, ORNIA 92253.
Owner
Mailing / BUILDING: TYPE CONST.______
^ 0l — 60NST. OCC.GGRPP..
Address S� --75,S�'V� V �G S(C� A.P. Number / 7
City / Zip` Tel. L J (�%• E+ J (�/ r / 7 !c
!', C Ukd� qZ � 3 S6LI 41662 Legal Description
Co tractor Project Description �_f• ��•
2 v t20r7_e 1 co I � ���'� •�
Address
P_ 4) - �k 3
City/ Zip.? 2 Tel ,Li�t1UL�
,,a- PL, Lr f�'a- 5
State Lic. c City
& Classif. j y / � j } Lic. # ZZ 6 / Sq. Ft. C No. No. Dw.
Size , Z /�� Stories Units
Arch., Engr.,
Designer New i]/ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic: #
LICENSII�D CONTRAC R'S DECLARATION
7,�I ereby affirm that I am ficensed under provisions of Chapter 9 (commencing with Section
0 of Divisio of the Business and Professions Code, and my license is in full forceand
Aetfe t. A // 7 /
!1 AC �/ r
SIGNATURE \ ty' v DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated. Valuation
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 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.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, 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.)
II I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strucI 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 S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
17 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop Line
CONSTRUCTION LENDING AGENCY Side Street Setback from C nter Line
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.) Side Setback from Prope Line
Lender's Name
R
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE 4 INSPECTOR
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Pef
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. Validated by:
Signature of applicant -Date-
Mailing 2 139 'Q /1
Mailing Address Validation: APR 0 97
City, S4ate, Zip
BUILDING DIVISION I CITY OF LA Ql. INTA
7
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F�
IST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL, SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO, FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. 4r,
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. @
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
BOND BEAM
MECHANICAL FEES
WATER SOFTENER
=$
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
FRAMING
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,TEMIPERM
LAVATORY
SPARK ARRESTOR
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
INSULATION/SOUND
SQ.FT.GAR @ 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
CERT. OCC.
PERMIT FEE
PERMIT FEE
FENCE FINAL
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
GARDEN WALL FINAL
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 APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
Not ice• 82-879 Highway 111 y -
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/4/97 APN # 773-091-005
No. 15598 Jurisdiction La Quinta
Owner Name Ismael Coronel r
Permit # ,
No. 51340 Street Avenida Velasco Log #
City ,La Quinta zip 92253 Study Area 113
Tract # Lot # Square Footage 1290
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 mobilehotnes.
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 1,290 or $ 2,373.60 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 Barik/Coronel Enterprises, Inc Teleplone - 564-4604
�F
Name on the check
By Dr. Doris' Wilson
L
Superintendent � `' r � �l,l wf ��, •
Fee collected /exempted by Pauline Pearson Payment Received $2;373.60
Check No.' 141454
Signature
OTICE:' Pursuant of Assembly.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
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
'Ilett 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
RECORDING REQUESTED BY:
ORANGE COAST TITLE COMPACOMPANY
96.5787KC R-151224-1.
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAR STATEMENTS TO:
ISMAEL B. CORONEL
and MARIA M. CORONEL
51-755 Avenida Velasco
La Quinta, CA 92253
P AID
Doc. Transfer Tax
FRANK K ,JOHNSON
Riv. Co. Recorder
196834
RECEIVED FOR RECORD
AT 8:00 O'CLOCK
MAY 2 91996
Recaoeo in unsaw necorc .
of Riverside counly,calitorrva. 111YYY
Recorder !"
Fees S l �r
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GRANT DEED
APN: 773-091-005
77L1�- ; O ZO 0) V
The undersigned grantor(s) de�lare(s)
Documentary transfer tax isi'$9.90
(XXX Ccr"put,?d r,.n ftzl1. valt.tb of nr.onerty conveved, or
Computed on full vale less liens -and -encumbrances remaining at time of sale.
Unincorporated areay ( ) Pity of and
FOR -A VALUABLE CONSIDERATIbIT,,Zeceipt of ::Anich, is hereby acknowledged,
STANLEY I. COHEN and ADRIENNE D. COHEN, as Trustees of The 1992 Cohen Revocable Living
Trust, u/d/t July 21, 1992
hereby,GRANT(S) to
•ISMAEL,B. CORONEL and MARIA M. CORONEL, husband and wife as joint tenants
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 5 IN BLOCK 63 OF UNIT 6, SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN
BY MAP ON FILE IN BOOK 18, PAGE 67 OF -MAPS, RECORDS OF RIVERSIDE COUNTY,
CALIFORNIA
Dated May 16, 1996
State of California
County of Lo S ',. ^ _ t S ..S •
ca " u'_.�f a,4, I,, ct
before m
personally appeared
stcj_�.,(e.�
Aek rip- yl v f) I C,keh
(or,proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) i&/are subscribed
to the within instrument and acknowledged to
me that he{-j:he/they executed the same in
/their authorized capacity(ies), and
that by h4-r�/their signature(s) on the
instrument the person(s), or the entity upon
behalf of which the person(s) acted., executed
the instrument.
WITNESS my hano and official eal.
Signature
MAIL TAR STATEMENTS TO:
STANLEY COHEN, Trustee
,. ..AE . COHEN, Trustee
(This area for official notarial seal)
/ • ^�
ni �p �u nen-� '-`.: � �ir i
bic. C;_:.;,: is
\\
fAy ccr mis ,nn f-:xriies
`,✓
c
SAY 10.1c
(This area for official notarial seal)