0306-160 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CNI
W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
r*_W kI OIf31i�'C
f\
oZ r— Date Signature of Contractor
0 O
I-"
VW OWNER -BUILDER DECLARATION
JD
W d 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
O�
V Q 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 i.I'i`s?Ntr Policy No. IS`S3%7-G;i
(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.
Date: Applicant-
Warning:
pplicant 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 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 complytwith all City, and State laws relating to the building
construction, and hereby with
representatives of this City to enter upon
the above-mentioned propertyfor inspection purposes.
i 1
Signature (Owner/Agent) �` Date
BUILDING PERMIT PERMIT#
1610
DATE VALUATION V9.%232. .}` LOT TRACT
JOB SITE
ADDRESS 53._(ge AvJCrri)A VY`JIgCo
APN
774-W-001
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C110RO'Po"EM' TUIRISWIS
VO ROW1 T Cl',aJMIA-MON
plc): bux 369
51.10. "t'TI, 11:IPA VIL I A 4'+01
i..A. QL:t1tn1 A. CA A�253
LAS. t~j1.1IATf'A CA 92253
(760)1164w4664 C13L# 2261
USE OF PERMIT
O'[i:TOL r'd"'Ugly' 1; WE11.124,13
1414 3,17. SK; AiPWIT OURS I307 TMC LIJIDIf AWCK WAS,i, PrX, , Or
DRNEWAY APPROACH
TRACT COMTFi.rJOINOW I,AX.00 y'
FOKCg?i PA ► IO ".00 SIT
0ARA(3Fft;ALtf'G T 52111" 2F
ZFMV.IV) C 061.1' or C'"ONKR'a"TC-"I:'301i
?3rRW.r PRE WWWAH d'
PLA14 CHICK FEE 161-000-4:;0.x'18 �iQ,s.7r
ri i:iz I:IISTI''�xi�I.ybk' .41:T,.s18 1:dx0.t�
A.E:tMICAiZ'
]01-,Ocq�' ♦,'.1-`/�
yUCrylIC—Ai M ♦ � � �' \n ���rf.; k �du".i,'`r pS S E 19, U�
PLifMi N10 Air 3 101 UO{1 i ss-•uC?() 31II,C
frPltOIvO Mfr: TION RM - RESIT} I0} -?XX -241- of,
ORAlaNO ME g 6 :t -000-ws 3-0ruo h.13;c
a �WEA><,PR>i. trAFM,7 , c4m.w
PRECISE N.AN ;W -,'.M -4/A-345 1s �tM1, bttJ
Q%11:iTOT-ALC'f.lriTlsl:riUi."` 01dA."MPIAN G`?,r1:':" .
$3,915, 5,4
L&'93 P1'tk,-'-WD T'I1 5
4230. DO
f e'P`AL x KRW C:r1"' KEN DUE WIiia
JUN 17 2003
C1TY OF LA QUINTA
FINANCE DEPT.
RECEIPT DATE
BY
DATE FINALED
INSPECTOR
G
J'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
_ Q
O.K. to Wrap
O
Framing
v
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drwrall -Int. Lath
Bond Beam
Final
Waste Lines
.Water Piping
Plumbing Top
Shower Pans
Sewer Lateral
Sewer Conner
Gas Piping
Gas Test
Appliances
BLOCKWALL APPROVALS
PLUMBING APPROVALS
Utility Notice (Gas) 1G-, %`( q_3 I Z>O
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
Utility Notice (Perm)
OPERATION I DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans 8 Controls
Final I
POOLS - SPAS
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
Encapsulation
Final
COMMENTS:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District 4C:0
47950 Dune Palms Road Q o
Date 6/16/03 La Quinta, CA 92253 RANCHO MIRAGE
r
{� INDIAN WELLS
No. " 24553 (760) 771-8515 �, PALM QDINTA y
IN
. _ +. - : ► _ _tom o J . •
Owner ' Coronel Enterpriises APN # 77.4055002 .
Address P. O. Box 389 Jurisdiction La Quinta
City. La Quinta Zip 92253, Permit # 0305266'
Tract # 216 Study Area '
Type, Single Family Residence ' No. of Units 1,
Lot # No. Street" S.F. Lot # No. -Street S.F.
Unit 1 2 53060 Avenida Velasco 1505 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5'• Unit 10
Comments • i+ ,
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-(spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation)'or replacement mobile
homes. It has been determined that 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
Education.Code Section 17620 and Government Code 65995 Et Seq.
in the amount of - $2.14 X 1,505 S.F. or $3,220.70 have been paid for 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 C/C Valley Independent Bank, Ish Check No. 277768
Name on the check
Telephone 564-4604-
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected'/exem d by Patrici Barbuzza $3,220.70
Payment Recd Over/Under +
Signature10
ce�(M cL.� 4 '
W
6
NOTICE: Pursuant to. Government Code Section 66020(d)(1); 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
RECORDING REQUESTED BY:
'—sctiUTHLAND TITLE - INLAND EMPIRE (Title)
AND WHEN RECORDED MAIL TO:
Lucas Coronel
Coronel Enterprises, Inc.
PO Box 389
La Quinta, CA 92253
Order No.: 63600234
Escrow No.: IN3644-KC
A.P.N.: 774-055-002-8
DOC N 2003-161229
03/07/2003 08:00A Fee:10.00
Page 1 of 2 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Cary L. Orso
Assessor, County Clerk 8 Recorder
IIIII
I
I
M sq LI PAGE SIZE DA PCOR NOCOR SMF MISC.
L- R( L 11 I I COPY I LONG I REFUND I NCHG I EXAM
GRANT DEE®
THE UNDERSIGNED GRANTOR(S) DECLARES)
DOUMENTARY TRANSFER TAX IS $99.00
[ X ] computed on full value of property conveyed, or
[ ] computed on full value less value of liens or encumbrances remaining at time of sale.
[ ] unincorporated area [ X ] City of La Quinta
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
John R. Vik, a single man who acquired title as John Robert Vik
hereby GRANT(S) to Lucas Coronel, a single man as to Parcel #1
and Coronel' Enterprises, Inc., A California Corporation, as to Parcel #2
the following described real property in the County of Riverside, State of California
Parcel 1: I
Lot 1 of BI'ock 216 of Santa Carmelita at Vale , in the City of La Quinta, County of Riverside,
State of California, as per map recorded in Book 26, Page(s) 22 of Miscellaneous Maps, in
the office of the County Recorder of said County.
Parcel 2:
Lot 2 of B
County of
Miscellam
Dated: Feb
STATE OF C
COUNTY OF
On --T b
a Notary Pub
appeared J
personally kn
satisfactory e
is/are subscri
to me that he
authorized ca
on the instrur
which the Der
ick 216 of Santa Carmelita at Vale La Quinta Unit No. 21, in the City of La Quinta,
Riverside, State of California, as per map recorded in Book 26, Page(s) 22 of
Dus Maps, in the office of the county Recorder of said County.
uary 3, 2003
SS.
i' 3 2 a -o 3 before me
in and for said County and State, personally
Ihn r:_. i);K
n to me (or proved to me on the basis of
ence) to be the person(s) whose names)
d to the within instrument and acknowledged
e/they executed the same in his/her/their
city(ies) and that by his/her/their signature(s)
it the person(s), or the entity upon behalf of
i(s), acted, executed the instrument.
WITNESS my,hand and official sea .
I
An ,,
Signature����`l-�'1c�� �; b
Signature of Notary
Jo R. Vik
:0 �.10TARy. Wim:
;U -a® Cn'
i cP PUBLIC
I'°4 9j6 -29-()b •' • --A�
f '� OF�tNAS`��\,.
(This area for official notary seal)
MAIL TAX STATEMENTS AS DIRECTED ABOVE