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9806-004 (SFD)LICENSED CONTRACTOR DECLARATION II hereby -affirm under penalty of perjury that l 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 --..--•• % � ��1.iiCit7 Date / Signature of Contractor i moi/. t 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' compen satia,✓a-�ided for by Section. 3700 of the Labor Code, for the perfor +•'ice 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. (330_1s1:,t4.9A(is',E fM.S. N 0,12139200 (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 ,,thisipermit is issued, I shall not employ any person in any manner so as to become subject to the, workers' compensation laws of C�Jifornia, and' agree that if I should Become subject to the workers' compensation provisions of/Section 3700 of the Labor Code, I(�s�hall'forthwith comply'=wltet ose provision Date: ti`� "/ i'%Applicant / E _Z.�af 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 SUC6 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 withoall'City, and State laws relating to the building construction, and hereby authorize representatives of .this City to enter upon the above-mentioned property for inspecti n purposes Signature (Owner/Age) 1 r `�� Dates PERMIT # r, CONTROL # - BUILDING PERMIT DATE fA.,a VALUATION *$9.4 3.,Q1 LOT ;� TRACT & "V 3 � 1�,{$ JOB SITE r ' APN ADDRESS al- 20E� V �t;s"v � it ' ►>' � ,1 ;ifd D` � 773414j-2-020 OWNER CONTRACTOR / DESIGNER / ENGINEER �Irt a "1 C` •moi ri' h'r ` Ya /lA `1 ; ip�c ,•t,�t p- r( •tis.1 ..., i i1 kta i. i�ttw A.'�fi • (;�'1,i�ai.� 1.1 i'. t� f�•�.�i.'t 1 t:,� 74„al If•,r, +, ;1iti,US--81K thin E*k DR. .51--40 (i40WERDk. LEI. QIJIN-I'A CA. 1AQUi1V'1'A CA. 92153 (1661564-4604 CB110 21101 USE OF PERMIT `iRe"Ll, CONSTflUX ION4, 1,42.1,00.w PORC"H411i0,1 D X"i- 111 91 GAkA0f•;/r_'AW—'0R:T 514,00 SF 611"'1•. WOOD T'111NCSI 200.00 CI ,.STIT4`iATED C'OST OF CONMIUC #'hON PERMIT WE INI MNIJARY C'ONSTRUCT(C)N.FEV lot -0001 fts-000 3594 PL. -V40 -W -VK 1+EZ 1014*419-3113 3502 NXCIIAE41CALI:EE $5:3 r: rl)a .'3'f cpdA i".HE 101.000-420-000 $173 PLUMBING %EE 101-000-4.19-000 SMA ;`31131:' NO MOTIf)'iV' >! rT -M-151n $3 ORAD .NI O FL4 101.000-4:17-000 $20 WI;'tWTRUC"!"[ RI, FE1 225-000-443-2142 51.902 PIWCISE PL AIN 101 -MO -4-11-345 $25 FEE 00,1081T 101-000-414-319 •50 .70 .0 .52 ,50 ,f+�l .00 .00 p F P� �� st 3 Ai, t::ON;+a!'Pe7 r r -r :N AND P3.l1.lsf C" d1;rl JUN 0 3 1998 USS PSE-PiMFEES 3 9; NTY tie T2 DATE DATE FINALED .`19.413..50 x,14'4.44 $3,174,44 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 Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing _7111040c_ Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulatiori Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final Final BLOCKWALL APPROVA S POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ 9 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ Pool Cover Sewer Connection 7d Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: ' Final Utility Notice (Gas) 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 I t Final Q q/Q Utility Notice (Perm) Q' �p 7 Building Address Mailing vvn�■�� ----- Address p■O■ 13OX City LA OWNTAi C • 4Q" r P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO lJ LA QUINTA, CALIFORNIA 92253 TRUCTION BUILDING: TYPE'C�OjNST. / -7 OCC. GRP. 3�9 A.P. Number 773 3 t�(L/��i�� l.YJ`r7 Legal Description.. �! L� _77,p Uzi, � �T�I If�T1A111 Project Description Address p,O■ BOX 389 %.rty rn pw■...._r -- 1_1 t!]. 5 e4/- 6no State Lie.�/�j City / & Classif. 3 / < 1 Lic. # 7,6 Arch., Engr., Designer Address I Tel. City �� -7 �,. IZIp (State I 1 , Lie. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section effect. of Divis of the Business and Professions Code, and my liCertse/.js:ift fu'ly7lofce and SIGNATURE I DATE OWNER•BUILOER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason; (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, 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 thathe is exempt therefrom, and the basis for thealleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). I-1 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 Caw 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.) 11 I, 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.) 171 1 am exempt under Sec. B. & 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 7 I t7 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 tho 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. after 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. 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 sof this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip 9 0 WHITE = FINANCE YELLOW a APPLICANT PINK = BUILDING DIVISION A Sq. Ft. Size , Si 4 f No. No. Dw. Stories r/ Units a� `New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation , PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. + Const. Mech. ! Electrical Plumbing S. M.I. Grading Driveway Enc. M.Av 90 -998 Infrastructure a . i 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: WHITE = FINANCE YELLOW a APPLICANT PINK = BUILDING DIVISION A .,-Desert Sands Unified School District Notice: _a 82-879 Highway 111 Indio CA 92201` y Document Cannot Be Duplicated 619-775-35.00 r. CERTIFICATE OF COMPLIANCE r Date 6/3/98 APN # 773-062-020 No. 17114 Jurisdiction La Quinta;, .I Owner NameCoronel Construction {Permit # ' No. 51-205 street Avenida Vallejo - Log # City La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1,421- Type of Development Single Family Residence No. of units 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 , 1.93 X •' 1',421 or $ 2,742.53 the property listed above, arid,thar ibiiildu?g="t�<< •_ permits and/or Certificates of Occupancy for this square footage in this proposed project=mJay now be issued,, ! Fees Paid By Cashier Check/VIB/Coronel Construction .56y "4604 F '' .: _ e ephoree �. t Name on the check' IV); By Dr. Doris Wilson Superintendent h _ it •. • Fee collected /exempted by ytJuanita,;Green Payment Received $2,742.53 L ` Check No. 1'66119 - Signature . i } NOTICE:' Pursuant of Asse ly 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 above will begin,to run from he 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 collect 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 ' V 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 , 1.93 X •' 1',421 or $ 2,742.53 the property listed above, arid,thar ibiiildu?g="t�<< •_ permits and/or Certificates of Occupancy for this square footage in this proposed project=mJay now be issued,, ! Fees Paid By Cashier Check/VIB/Coronel Construction .56y "4604 F '' .: _ e ephoree �. t Name on the check' IV); By Dr. Doris Wilson Superintendent h _ it •. • Fee collected /exempted by ytJuanita,;Green Payment Received $2,742.53 L ` Check No. 1'66119 - Signature . i } NOTICE:' Pursuant of Asse ly 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 above will begin,to run from he 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 collect 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 ' EscrOw COrPOralion �,y '.�K� 'i; �ih �� ., ,• ' �� / v�/��I � J • .- • •a5 � 4 r� Sdt 1 ' 4, 74-920 HIGHWAY INDIAN WELLS, CALIFORNIA 92210 TELEPHONE,(&1q TO: PACIFIC COAST ESCROW CORP., 74920 Highway ill -Indian Wells, Ca. 92210 'RE:17763- I hand you 'herewith a'�QUITCLA' IM Deed executed by the unders' CORONEL, WIFE of Grant'ee, to ESEQ igned,;jj' UIEL M. CORONEL, HUSBAND o HIS sole and separate,properiy. f Gra: for described subject property AKA: :-LOT 9 IN BLOCK'72 OF AN TA-CARMELITA AT VALE LA QUINTA, UNIT NO. SHOWN BY MAP ON FILE IN -BOOK 18, PAGE 69'OF MAPS COUNTY CALIFORNIA RECORDS OF RIVERS, which h' h You are authorized to use in the above numbered escrow collection� for my account,. as I have w withd'�4 _'Out- received full �'onsideration Of escrow. No documentary tax stamps are to -be 'tMaS HEREIN ACKNOWLEDGE ESCROW Jug P aff HOLDEf, OES NOT L• VICE OR PREPARE LEGAL DOC PRACTICE LAW, SH-- UMENTAT11 i4- PARTIES -HEREIN ARE G - I T %5.. HEY SO CHOOSE, TO SEEK THE ADV -tTW� AD WOF THEIR -OWN ATTORNEY AND THFE, RE, .FULLY INDEMNIFY AND HOLD ES. � 'HOLDER HARMLESS E AC ."WOW AND -IN THE FUTURE IN' FROM A14y GAR C4? THIS TRANSACTION -ES'S OMPANIES ARE NOT AUTHORIZED T'0A LE VICE, PLEASE CONSULT AN TO YOU N " 4 ' 'I E LEGAL ADVICE. ATTO iV IF D1 I.0 J'lb (S) e�NTEE (S) HAZANX CORO EL i. jo I