9606-017 (SFD)LICENSEDCONTRACTORDECLARATION
co I-,. I hereby affirm under penalty of perjury that I am licensed under provisions of
t I '' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cel UJ Professionals Code, and my License is in full force and effect.
O 0 ce), • ' License # Lic. Class Exp. Date
634,
r,� w � /./t(i(
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Z /ate �L 7- ��Signature of Contractor , r
O r� / ' l ,1 ttrt/
U — a OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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). ` . ' .
( ) I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
CL
p Z I hereby affirm under penalty of perjury one of the following declarations:.
Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
CIO Q U ( ) 1 have and will maintain workers' compensation insurance; as required by
O USection 3700 of the Labor Code, for the performance of the work for which this
Il rn H permit is s7 U480' Myttworkers' compensation insurance camer90o' i'cy no, are:
`t Z Carrier Policy No.
ab 0
C)
J (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'4ree°that if,1 should beecaome-,,,
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Co6e1 shall forth kith comply viith those provisions.
L�ate:e-^ Z 7-> %•pplicant d./ /+/,' r i
Warning: Failure to secure Workers' Compensat ocoveerrag� lawful 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
,the above-mentioned property for inspection purposes
Signature (Owner/Agent),
PERMIT# CONTROL#
BUILDING PERMIT
9-037 3626
DATE'��{� VALUATION �!�j,4%!),�(� LOT' TRACT'
JOB SITE 51-560 ��, N� DA Vi:.L.A,SCd)
APN 773134402
ADDRESS
OWNER
CONTRACTOR /DESIGNER /ENGINEER
s..Quui5. &I.Cow)NhEI,
CR�wOa``L F;ISlJMPN.
P,0. 63OX 3854
717836 AV EN IDA MONTEWMA
LA Q1..IiN'i'A. CA - 925.53
1.A. QUIN"FA CA 92253
(lit S(ic1-:i�i�R
�C.19 5 4-461)4 MIA 2361
USE OF PERMIT
pHOLE �` ` jtI( y��
1 21�AdVti.la [F'"�YY C: LUNG
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POR CH!f'61,` IO 38.Utt !
415.txr 3
U FUMA TED C09T OF t, ONS1,1.`QJMION
01,479.90
&'4 HIMIFT ZI EK Sr)MIMA14
;04-000-41840
4'I.t1.N CHECK 1.1.,E' 14�1-tt�f} si.�Q-318 �5t� .03
Alllrl r)HP05111 4 50m
nt. i�13t��sicA :.r 1101 -000-421-00 553.50
0. R(.71110CALEms; 1 5.875
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0RAlXN0 --.R i tU.i-tjtIU-443-tnN) $200,11
iNE�it,A'b'['iil.f("•t't.1tLE.fihT:. .27.5-4}t9(1,443�:i€�� ;�2,t?7.57
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lat�;��:"1,�1:�'�.At� i01-Of'E!•ri.#f-:34� �'�,5:i�
SUB:IVOTAL CONST10C'1'ION AND PLAN C HRCK
LESS PH 8_1D FEES
JUN 2 7 1996 ------
By
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
t OPERATION
' DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/$
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
/ .
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�p
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVAL9
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
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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated
y
Date 6/27/96
No. 14646
Owner Name Esequiel Coronel
No. 51560
City La Quinta
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Street Avenida Velasco
Tract # Lot #
Type of Development Single Family Residence
Comments
APN # 773-134-002
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area 113
Square Footage 1490
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: ,
a
EXEMPTION NOT APPLICABLE
This certifies that.school facility fees imposed pursuant to Government Code 53080 "
in the amount of 1.84 x 1,490 or $2,741.60 -
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.
A v
Fees Paid By cc/Bank of the Desert/Esequiel Coronel Telephone, 564-4604
Name on the check 1 ..
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2;741.60
Check No. 16508
Signature
-bollector: Attach a copy of county or city plan check application form to district copy for all waivers.
Eib ossed Original -:Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
jW
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• BR
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Vui_t"
t tu a--
Mut, to t13 va. t 113 n
This Certificate issued -pursuan.t'to the requirements of Section. 306 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:
..51-560 AVENIDA VELASCO
BUILDING. ADDRESS
use classification single Family Dwelling Bldg. Permit No. 9606-017
Group R-3 Type Construction VN —Fire Zone Use Zone SA
Owner of Bull -ding .,Esequiel. Mcoronel_ -Address P.O.Box 3_89
City La Quinta, CA., 92253BY: D . aniel- P. Crawford Jr.
-
()ate. August 29,,1
Building Official 47. POSTAN i'COMMCUOUS IPLACi