0209-103 (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. Datey,
f
634981
,
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:
( ) ' 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
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
S$ tion 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:i
Carrier .STIA`PE FUND Policy No. 1543V47-01
(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' compensations provisions of Section 3700`of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage isZ,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 isnot 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 tothe building
construction, and hereby;authorize representatives of•'this City to enter upon
the above-mentioned property for finspectiori' purposes.;
Signature (Owner/Agent), ` J; �'4 '' Datey
'BUILDING PERMIT PERMIT
DATE g 20 D 2 VALUATION } $671'f?3: 5.113 LOTr; ,7 TRACT -P, 216 U-�
,r
JOB SITE d•� APN
ADDRESS F��".'„$.4.40 _AYE -NWA �rsco
OWNER r CONTRACTOR,/ DESIGNER / EN (NEER
F0B0X 389 'i:cllz-1 50 C.,NIAIE TAAMCO SU19vv f230
I. h QX!`t~c'�I'x A C''.A, 92253 LA. QUDnA CA 592203
2261
USE OF PERMIT
mumrz
14.21 SY. SPID. PERMIT T DOES NWT MCLXI.11.:, BLOC. WALL, POOL OR
ORNEWAYAPPROACH
MCT 0' ANSTRUC' ION 1,421,00 u!?
P C)1'OHJPf#VO 36,00 Sid
0,k1R.A091CARP0RT $191 Do ar
N
1M X+y�Y�F,1 of ••��yy ls� f is p�YF+�Ty �1,� fie•`-••`•��9
Ld.iJ^'" 6da1'7.R. - C 79 A.LC�IC 101- 45.1` , 9.•�dad'iL1t 6-..fT,l,'. CUK
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42,50.00
'AL PrRWT "26 MY&NOW
OCT 2 R 1001
CITY OF L,AQUINTA
RECEIPT D ` ,ay DATE FINALED INSPEC O
&/Z�/oz Aa 50-?
PYSM)PI 112r, SUM wircy
COHYMIRUrwY'1OA FEE
101.000.413>.000
P1,AN CHLtX FFM
101-00 0-139-318
1 "
S EYOSIT
101.000.439.318
-$234
J+B9C1•i.ANiC.AL FEEFEE101-000-
� 2 1-000
���rfuL, FEE
�'
101-000-47,0-000
��
PLU.'ADI �f4'FEE
101-000-41.9-000
$11t5
F+.fO t *14 VVIR - RMD
101 RC�#1t -2441.0000
�
,t'7�c�tdg+�0
.1071-No-C�'G.�-wo
10,1
$r-.
DEVELOPERJIMPACt 1•i'L
$449
'3 F 1. " P1. A13 ` "
10 1:. (gyp -441-345
' J€t
N
1M X+y�Y�F,1 of ••��yy ls� f is p�YF+�Ty �1,� fie•`-••`•��9
Ld.iJ^'" 6da1'7.R. - C 79 A.LC�IC 101- 45.1` , 9.•�dad'iL1t 6-..fT,l,'. CUK
Q,so
6.42
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,�7.7S
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�+.00
U. pYf
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42,50.00
'AL PrRWT "26 MY&NOW
OCT 2 R 1001
CITY OF L,AQUINTA
RECEIPT D ` ,ay DATE FINALED INSPEC O
&/Z�/oz Aa 50-?
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
kL-
Return Air
Steel
Combustion Air
Roof Deck
, Q 1407— %
Exhaust Fans
O.K. to Wrap
/- Q
F.A.U.
Framing
Insulation
/_/0-0-31
Compressor
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 U3
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
_U
Appliances
-
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVAL
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 (Penn)
COMMENTS:
!�—
Date
10/28/02
No.
23784
Owner
Coronel Enterprises
Address
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence '
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
��FIEDSCC
QQ BERMUDA DUNES t^
RANCHO MIRAGE
INDIAN WELLS
PALM DESERT
c� LA QUINTA
�INDIO y71.
p
774-055-006
La Quinta
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 7 53140 Avenida Velasco 1421 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
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 (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 1,421 S.F. or $3,040.94 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 CCNIB - Ish Coronel Check No. 277876
Name on the check Telephone 760/5644604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,040.94 $o.00
Payment Recd Over/Under
Signature
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
MAR -05-2003 06:57 AM
INSTALLATION CERTIFICATE
to Auaress
t Nu
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
r . e e
CF -6R
DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA) G�
Test Leakage (CFM)
Fan Flow
If Fan Flow is Calculated as 400 cfinhon x number of tons, or as 21.7 x Heating Capacity �)
in Thousands of Btu4u, enter calculated value here
If fan flow is measured, enter measured value here
Leakage Fraction_ = Test Leakage/(Measured or Calculated Fan Flow) = ❑
Pass if leakage fraction s 0.06
Pass rail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
❑ Yes ❑ N. ❑ Pressure pan test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duet Connections /JV/ Pa ❑
P89S Fail
Q� THERMOSTATIC EXPANSION VALVE (TXV)
eyes ❑ No Thermostatic Expansion Valve (or Commission approved ❑
equivalent) is installed and Access is provided for inspection
Yes is a pass . Pass Fail
❑ DUCT DESIGN
I ❑ Yes ❑ No ACCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation thatches
plans.
2• ❑ Yes ❑ No TXV is installed or Fan. flow has been veritiod. If no TXV,
verified fan flow matches design from CF -IR.
Measured Fan Flow s
Yes for both 1 and'2 is a Pass Pass Fall
I, the undersigned, verify that the above diagnostic test results and the work 1 perfort'hed associated with the test(s) is in
conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -611
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for
compliance credit.]
TestsSignature, Date Installing Subcontractor (Co. Name) OR
Performed v General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
[p =S; In 0 *on
JF f
0
T Build On
REPORT OF FIELD COMPACTION TESTS
TESTED FOR:
ION
CORONEL CONSTRUCTION
PROJECT:
53-140 AVENIDA VELASCO
PO BOX 383
LA QTj11,JTA, CA
LA QUINTA, CA 92233
DATE:
November 05, 2002
OUR REPORT NO.; 07320291-2
TEST DATA:
(1) medium to coarse graine(I wilt
sand. OPT.
MOIST, -.11-094
.
TEST
. . ..
... ... ........
TEST
604. ID
M=Mum
LAD DRY
WATER
.
WZT
DRY
P1�110FNT
C(WMENTS*
Spec. 90g Min
NO.
DEPTH
ELEVATIONNUMBER
DENSM
CONTENT
NSIrl
COMPACTION
1
oil
Fe
1
.-.20.0
8.5
117,7
108.5
90.4
1 A
:2
81,
FQ
1
:!_20-0
8.9
119.7
109.9
91.6
1 A
r3
8 11
FG
1
120 . 0
7.6
116.4
108.2
90,2
1 - A
4
Sty
FG
1
20.0
7.7
117-5
109.1
90.9
1 - A
-7
TEST LOCATION. Building pad.
1 NW corner,
2 NE corner
3 SR -corner
4 Sm corner
NOTES: TESTS PERFORMED PER ASTM 132922-9S &ASTM 03011-115 *COMMENTS: 1. FILL MATERIAL A TW R WS COMPLY NTH SP C)FICKn
P TION DOES
0
DE MWILL S. T comPL?N$
"SIT' ?Ok"EONT W IjCA Nr
WATER E COURSE
PF. R ST
,RCF
N MP mum dry SUBBASE
'M
MV
d8nSity Obtlifted on sampie indi=ted by 81 1 Ek VEC,,,cAT,0N8
064 W
too lryflun%,�r. SPECIFICATIONS
.(I) ASTM D1557-00'METHOD A
TEST INSTRUMENT: STANDARD COUNT K
REMARKS: PSI did not monitor the matel.ial placement. ADJUSTMENT DATA M:
Respectfully submitted,
TECHNICIANx Vinnie De. Souza Prafossional SerWce IndusWes, Inc.
THESE TEST RESULTZ APPLY ONLY TO THE SFECWM LOCATIONS NEITED AND WAY NOT REP MaENT ANY OTHM LOCATIONS OR ELEVA71048.
Pfofession2l Servioe Industries. Inc. • 42-240 Green Nay. Suite C • ftrn
vs A- IUD -2 I5F Desert, CA 92211 •Rhone 76041,5790 -Fax 760/341-5794
I d 098 ON Nd00:Z1 ZOOZ 1 '080
Certificate of Occupancy
City of La Quinta
Building and Safety Department
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:
BUILDING ADDRESS: 53-140 AVENIDA VELASCO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0209-103
Occupancy Group:
R3
Type of Construction: VN
Land Use Zone: RC
Owner of Building: CORONEL ENTERPRISES Address: P.O. BOX 389
b'tt
Building Official
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: MARCH 11, 2003
POST IN A CONSPICUOUS PLACE