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0310-340 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am'licensed under provisions of Chapter,P (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 1I 634981 B 1� i t3i131/2C 1/Date 'e 7 �' Signature of Contractor-_.. -• ,A 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 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 STATR MID Policy No. 194243743 (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 should become subject to the workers' compensation provisions of Section 700 of the Labor Code, I shall forthwith comply with,those provisions. Date: + � % Applicant %\ A, ``t of 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 comply(with all City, and State laws relating to the building construction, and hereby authorize representatives .6i this City to enter upon the above-mentioned property for Inspection purposes. / Signature (Owner/Agent) • �� ' Date "' 7 �• "> T.� BUILDING PERMIT PERMIT# DATE 7 r ` VALUATION. , LOT1i TRACT JOB SITE ADDRESS126 A M. A.YMUwCO APN OWNER CONTRACTOR / DESIGNER / EN 1NEERR GOlt.ogM. EIMPPP-11SES. .. cow>w.�..CoNarRYJv1 ow P013oXnO 31-T05AVENIMAVILLA #101 LA QL1•.tN A CA 92253 L. Cr U1*A CA 92253 ('1Y60)5,64.-4604 !F3;Da 2261 USE OF PERMIT SNOLE,FAtasJTI:Y DWY.. ..WrO 1560 SIP. CFi3 PEkmrr DOS XO d iN>r't.0naP,' HLIDCX V/A.d.%,,POOL&PA OR DRIVEWAYAPPROACH TRACT CONSTRUCTION 1,50,00 SP ' POl:CHIPA710 32.00 SIP 0ARACMCARPOW 482.00 SP Isri dATW cOST OF COE4TSMUCTION �a�f��•K ' PERM'a M1y::raKIBMAR 1i CONS a MICTION PEE 101-000418-000 $617.00 . PIAN CHECK FEE 1.111-(1138 43�'-31$ $5'1i.iI'! FEE DEPOW tai-tFf1(?-43�-�1�-S24�i.9U . MF HANICAL IfiEL, 101-000-421-000 isTe1 ,TR1C.AL FRE 101.000.420.000 S11.2,34 PJAUMBING FEE 101 -000 -41? -000. $.318.00. STRO140MOTION tE9- RESID 101-'000.241.-000 $0.42 ; ORA.DINO arm' 101-000.4'23-000 $13.40 DEVELOPER RACT P79 PRECISE PLAIN 101-000-441-345 SUB-',tWAL COY4'SD'RU "aQ11 MD FLAW �.�'1^S M $3,941.1,"s LESS PRE -F AW I -;250,00 omt Pswdff frEES DUE Now DEC 17 2003 " CITY OF LA'QUINTA FINANCE t?EPT. i DATE yy BY�' DAFINARECEIPT IN SPECTOR� 2 14. INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APP O ALS 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 BLOCKWALL APPROVALS 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 — Q Heater Final Water Piping _ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans _O.K for Finish Plaster Sewer Lateral _ P,.00l Cover Sewer Connection — Encapsulation Gas Piping Gas Test Appliances 'Final .COMMENTS: - Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole .p Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors _ Temp. Use of Power - Q Final V Hty Notice (Perm) Buildi 1 4 j u�l'ItrGv P.O. BOX 1504 APPLICATION ONLY / 78-495 CALLE TAMPICO _ `abv A c- C� LA QUINTA, CALIFORNIA 92253 Owner Address City Zip Tel. Contractor Statei�Lr City ��( & Classit. f. G `s (, Lic. N Arch., Engr., Designer Address Tel. ity lZip I State of Chapter 9 (commencing with SAction Code, and my license is in full forge and �fi,,m ZemptNER-from t R DECLARATION . I hereby a that I a exempt from the Contractor's License Law for the following reason: (Sec. 1.5,Busi ss and Professions Code: Any city or county which requires a permit toconsfmprove, 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 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I: 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, 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'I 1, as owner 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.) 1-1 1 am exempt under Sec. B. ti. P.C. for this reason Date Owner 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 fl Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. 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. 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. 4 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 applicant Date Mailrng Address City, State, Zip WHITE = BUILDING DEPARTMENT BUILDING: TYPE'CONST. OCC. GRP. A.P. Number -7-74-a\S`'�A_% Legal Description \_a --7 Project Description-�' \,, Validation: � r YELLOW = APPLICANT PINK = FINANCE r Sq. Ft.No. Size � 1 No. Dw. Stories \ Units New,K Add ❑ Alter ❑ Repair ❑ Demolition ❑ a Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading It U11— Driveway Enc. Infrastructure FINANCE D TOTAL 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: Validation: � r YELLOW = APPLICANT PINK = FINANCE 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 1,560 S.F. or $3,338.40 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 CC/Valley Independent Bank-Ish Coronel Check No. 297758 Name on the check Telephone 760/564-4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon MCGilvrey Payment Recd �- $3,338.40 Over/Under Signature C 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 6 CERTIFICATE OF COMPLIANCE Jitsc� Desert -Sands Unified School District ° 47950 Dune Palms Road QQ BERMUDA DUNES r Date 12/17/03 La Quinta � CA 92253 RANCHO MIRAGE (� No. 25285 (760) 771-8515 '+ INDIAN WELLS DESERT �� PALM LA QUINTA y OINDIO 0 Owner Coronel Enterprises APN # 774-215-007 Address P O Box 389 Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0310-340 Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 7 54126 Avenida Velasco 1560 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 1,560 S.F. or $3,338.40 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 CC/Valley Independent Bank-Ish Coronel Check No. 297758 Name on the check Telephone 760/564-4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon MCGilvrey Payment Recd �- $3,338.40 Over/Under Signature C 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 6 10/29/2003 02:40. FAX First Arnei-i; an TivH ;coinoanv RECORDING REQUESTED BY: Fidelity National Title Company Escrow No. .410934 -CB Title order No. When Recorded Mail Document and Tax Statement To: IX v Mr. Zeke Coronel 51105 Avenida Villa, #101 La Quinta, CA 92253 rr- FIDELITY NATIONAL TITLE 1a002 51 q20 r4A�'1VegPC a 2003 0047538 10/14/2003 08:00ii Foa:30.00 5F045 D �� Page 1 of 2 Doc T Tau Paid _ Recorded In Official Records County of Riverside Gary L. Orso �j3_`7/1G Oy'Yal I Assessor, County Clerk a Recorder JJ �V�JJ ✓�VV-CX`//It V rAPN: 774-044-014- _ l U The undersigneedd grra t rrls) are(s) i� Documentary transfer tax Is $302.50 1 I X I • 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 City of La Quinta M 5 U PAGE SUE OA PCOR NOGOR SNi Sc. A R L COPT LONG REFUND NGNG EXIW FOR A VALUABLE CONSIDERATION, receipt of which is hereby' acknowledged Trustee of The Henry Griswold Living Trust dated June 19, 1995 hereby GRANTS) to Coronel: Enterprises, Inc., a California Corporation the following described real property In the City of La Quinta County of Riverside, State of California: SEE EXHIBIT ONE ATTACHED HERETO AND MADE A PART HEREOF DATED: September 19; 2003 STATE OF CA-tFORNIA COUNTY OF ON ,b c.�.�o . 7 before me, a• w orsonally appeared Personally known to me (or proved to rlie on the basis of satisfactory evidence) to be the personIq whose nameNLislaps subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/Nr/th"bir authorized capacity(i w, and that by his/h' xVtftwr signature( on the instrument the person(K, or the entity upon behalf of which the person( acted, executed the instrument, Witness my hand and official seal, Frank M. Griswold, Successor Frank M. Griswold, Successor Trustee of The Henry Griswold Living Trust dated a 19, 199-5 Frank M, Griswold, Trustee LINDA A. GAGNON Commission i 1313093 Notary Public - California z� Orange Counly My Comm. Fires Jul 13, 2005 Signature MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 7/96) GRANT DEED cor prop - RV:2003 00804798 1 of" 2 10/29/2003 02:41 FAX Escrow No. 410934 -CB Title Order. No, FIDELITY NATIONAL TITLE EXHIBIT ONE 0003 Lots 2, 7 and 10, Block 175 of Santa Carmelita at Vale La Quinta, Unit #18, as per map recorded in Book 19, Page 31 of Maps, in the Office of the County Recorder of said County. known as APN #774-044-014-5, 774-044-019-0 and 774-044-022-2 Lot 7, Block 281 of Santa Carmelita at Vale La Quinta, Unit #26, as per map recorded in Book 50, Page 20 of Maps, in the Office of the County Recorder of said County. known.as APN #774-215-007.7 Lot 8, Block 137 of Santa Carmelita at Vale La Quinta, Unit #14, as per map recorded in Book 19, Pages 82 - 83 of Maps, in the Office of the County Recorder of said County. known as APN #773-093-003-0 I�gtl�Gtld�I�IME�I�N�INII�W�p •'°•��Ge, ,_ cor prop - RV:2003 00804798 2 of 2 RC DISTRICT - PLANNING REVIEW FORM This form is to, be used by CDD staff for review,of single family dwellings in the RC (Cove Residential) District per Section 9.50.090 of the. Zoning Code. Its purpose is to determine: 1) that the proposed housing design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmit this. information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT: s �fttI -L C-9451 SITE ADDRESS: 54 - [2% AVL II6-U06Gfl APN ��`f' 215 - OD�1 CASE NO:: LEGAL: LOT; BLOCK UNIT S.C.@V..L.Q. CHECK AND -APPROVED BY: DATE: Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers.. . REQUIRED ]TEM Y N COMMENT/CORRECTION Verify legal and APN information Consistent with MDG on file (as applicable) MDG filing required (5 filings since 9/3/98) Architectural variety -within 200 feet of the surrounding area: Architectural design features Approved bv: at Res # ity Council Vommunit Dev. Dept. _-Initials VVI vv% Case No. _?v-� - 010 Exhihit O With Conditions Other Requirements: ................ .............. ... ........ ...... ... .. .. ... . .. ... ............ .. . ..... .. . . Aw 0Wj_ Loll ccu na�n.c-. /* .0 e r. v Ti c a --;, *� r r. � ) -t C:r r f. i4 ��'1I�'1j�� .3 _ _ �� •� �� r 41 JWWR?o'A= 1z Safe.. dmibfit J;y";,k-Buildih qpa OF A 7, jv Ar y - uant,4H6,requirements of Section"1091of the California- ~Building is " iThis,Ce�rtificatd'is'is.,�ued-pu' 6 -Code,- 64e1rifyifigthat.at. e.vmd 'of _*issuahce, -this'-1struc are was .4n-comP�liance with ',theA -the'Bdilding' e6ddi and- the `various dkdinances,oP e,'Pi(k regulating buildin9 provisions of and/or US6' .construction Z k, 1 1 e - BUILDINGAD[7 )RESS:,'54 126 "ENIDA VELASCO �P -A mi 03 0 classification`. LNDWELLINd" BUildinb';Fr5),,6r: t Use ,SINGLE Land, Use Z, 106cupand,�_Gr&#-R=3 Type'of 'Construction: N Zone. RC -30 - Zd - t "b -s' ox, n6r.of BUildibg C RONEL ENTERPRISM, 'Address.-P.O: :-P. -B 389 0 'ZIP IA�QUINTA, CA'92253 C By:,S TEVETRAX E L. Date A6-15-2( )047 � . - x. � �� ° .�r'�� ,. { N s -Official:' � �a. �°- � ?� : ,T r s,� -, �,: _'Building � y t V3 POST 'A CONSPICUOUS PLACE; 6i, -