9711-072 (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
ai B 1/31199
a ✓
/'� �,%''7'i r ria, /ate . .. 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:
( ) 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
— v
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.
(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
wor 'ers' compensation laws of California, and agree that if I should become
s,lbject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. C --
Date: Yo 9h t /!; -:---Applicant
Warning: Failure to secure Workers' Compensation coveragei� s�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
t e above-mentioned property for inspection purposes.
Signature (Owner/Agent) r' -� '- -'�Date I /?c �
s
PERMIT # CONTROL #
BUILDING PERMIT
DATE VALUATIONl9 /v�l✓J . LOT. y TRACt
c 1
?
1
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ADDRESS 51-5rJ:1 ES �r�,l'11. � �'- I1�� +C�
JOB SITE'1
APN 773 1..�-QSt.'}
OWNER
CONTRACTOR / DESIGNER / ENGINEER
P.O. BOX 399
P.O. BOX _489
1..A.( UlN'!A CA 92253
LAQUINTA i:A. 92253
(7610),%4-4604 C401,fi ?xti}
t
rys
USE OF PERMIT
tx
:AFD • PE:RMI T DOES, NOT it10,01)a uock,. w.iELw OR f',,JOL, ad -t. � ' - _
AW
INC UI A; 2(Wj LY., & Uv't.)t W F'ENC"f ,
TRACT CONSTRUCTION 1,421.00 Si'
�CITY�.JrLA
Of�9 {u°�j�A ' i
I't3f.tC IL'PA'ik.-Od1 S
10
fiALi11UEJC:AIt?'UJt'.I' Sj4,00 Sk
Fy
S F11. WC OD F EN<71; 20f).t?9 Gfi
,a
r t,
:4'e +,:CaN.
39 4 i 3.54
PPRMTV FEE, SLJMMAIR
CONS'1't21,I{`.1'IC)Rr FFF_ 1014 )04118-000 $'194.5()
FT.tNwCIPY"K F,R t0t-t?v-4.-to-31K
i42X'Itil llICAL 11M 1014vio-412.1-000
f,LE,Cl2tlCPJ, 1:t.E f01.-000-420-000 593.52
K UMBtNOfrr�
14110Nf*~. Int Y1110N rr;t# R"FS11:1 101-�3(t.-'?i1t-F1t.0
r3rV141l W0 FIR"s 101 -MO, 4:'3 -WO 32t1:C111
t14-1idtAfIT,.i2.0+.'TO1 k__ FR 225 -OW -4,13-342
PIXEC:ISE, !'CMN 1.0 1 -O}!? -441-3M S�5.fx1
VF?I;. I"Ft! P`)RIT 42.5000
;'(Rt- MT L r'ONS `RILI , FRON A1di:) PI...A1V
LESS PRE-MIDFEES
- =-so.i0
TOTAL, PF1ti1' VY ".UPS DUE NOW
$3, 121.44
RECEIPT
DATE
BY lj
DATE FINALED
INSPECTOR T
_41�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Z
Underground Ducts
Forms & Footings
,
Ducts
Slab Grade
Return Air
Steel
Roof Deck
'
Combustion Air
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
BLOCKWALL APPROVAL
POOLS - 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 �a
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service -
Sub Panels ,
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
r
Final
Utility Notice (Perm)
COMMENTS:
Building
T4`�t 4 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
0. SIC a LA QUINTA, CALIFORNIA 92253
v vin �cr
ie 671)I r� Otront -I
Mailing PO
Address
City � • �y Zip Tel.
( 10 r_01.'I f. I L. inn zzb-C
Address �G 3 E
CityL_, Zip . JAS Tel.
y' � �le�"44is
State Lic. City
& Classif. 3� �/ Lic. # Z
Arch., Engr.,
Designer
Address Tel.
City (Zip (State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy allium tKa-PI am licensed under provlslons of Chapter 9 (commencing with Section
effect.
of
0 3 of the Business an 'Professions Code, and_my license_is In fu��o`r�ce
effect. " `
SIGNATURE- '•-•�"`-'�` `""�'�"""""` Y DATE
OWNER -BUILDER DECLARATION
Ihereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or County which requires a
permit to construct, after, 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 (of a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
f.: 1, 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 will have the burden
of proving that he did not build or improve for the purpose of sale.)
1'1 I, asowner 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.)
I1 I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to sell -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. O 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 ($100) 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, alter 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.
i
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 a0plicant Date
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.`
A.P. Number _77Z — 13 3 t'1%7 — 3
Legal Description X2, x' <— . /,144
� r
Project Description
2
SFt.
Si
ze
New" JCS
on
No. Dw.
Units
Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
, o)
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
INSPECTOR
S.M.I.
Date ' Permit
Grading
wff
P
Driveway Enc.
Infrastructure
Validation:
NOV 1 9 1997
TOTALL
S J • U•>
REMARKS
ZONE:
BY:
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:
wff
P
li__
Validation:
NOV 1 9 1997
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISIOID" LA ("WA
Notice: -
Document Cannot Be Duplicated
It. .
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 12/18/97 y APN # 773-133-014
No. 16418 Jurisdiction ` La Quinta
Owner Name, Esequiel Coronel, Permit #
No. 51-555 Street Avenida Velasco Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # F Square Footage 1421
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
1.84 X 1,421 or $ 2,614.64 " 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 ec/Valley Independent�Bank/Cornel Enterprises ;:Telephone '564=04i%504
Name on the checkU.
By Dr. Doris Wilson'
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received
�2,6
Check-No. 150530^
Signature � QvtnQ 1�dQ Q1t AA�yL
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 '
."act 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
SALE ESCROW INSTRUCTIONS
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY!
TO: COMMONWEALTH LAND TITLE COMPANY
72855 Fred Waring Dr.
Escrow No.: 97.6986KCG;
Date: 11/12/97
Suite A5 Page: 1 f
Palm Desert, CA 92260
(76.0) 836-3726
Escrow Officer: Kelly Collier
THE ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED
BY THE CALIFORNIA DEPARTMENT OF INSURANCE. ,
Buyer will hand you additional funds prior to closing in the amount of ..... :....$ 11:0:0,0:00
TOTAL CONSIDERATION $ 11;00.0.;00
and any additional funds and instruments required from me to enable you to comply with thes.e.,
instructions, which you are to use on or before December 11, 1997, and when OLD REPUBLIC TITLE
COMPANY can issue a Standard Policy of Title Insurance Owners form, with liability of
$11,000.00, on real property in City of LA QUINTA, County of Riverside, State of CALIFORN1A`vit
Commonly known as: APN 773-133-014-3, LA QUINTA, CALIFORNIA
LOT 2, BLOCK*52 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 5, AS SHOWN BY
MAP ON FILE IN BOOK 18, PAGE 63 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA
Except any reservations of record of minerals, oil; gas, water, carbons and hydrocarbons.,
Showing title vested in:14
ESEQUIEL M. CORONEL, A SINGLE MAN
�.
Free from encumbrance except:
A. Current general and special taxes for the fiscal year in which this escrow closes, and
taxes for the ensuing year, if any, a lien not yet due or payable.
B. The lien of supplemental taxes, if any, assessed pursuant to the provisions of Chapter.
3.5 (commencing with Section 75) of the Revenue and Taxation Code of the State of
California.
,
C. Special improvement assessments, if any.
D. Easements, rights; rights of way, covenants, conditions, restrictions and reservations of
record.
w
4
61
C.ertifica te0j. of� Occu anc �
- ,
Cityof.La� uinta
Building and Safety. Department„ F
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:
w
BUILDING ADDRESS: 51-555 AVENIDA VELASCO '
Use'Classification: SINGLE FAMILY DWELLING Bldg.. Permit No.: 9711'072
Occupancy Group: R-3. Type of Construction: VN Land Use Zone: RC
Owner of -Building: ESEQUIEL CORONEL Address:-.. PO BOX 389
,City: LA QUINTA,',,CA., 92253°
By: DANIEL P. CRAWFORD JR.
Alga,
Date: 3/3/98
Building Official
< POST IN A CONSPICUOUS PLACE