0103-004 (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. Date
rte-.
+,�
Date R'' Signature_ of Contractor''' 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
saleh(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).
O I' am exempt under Section B&P.C. for this reason
Date Signature of Owner `
S WORKER'S COMPENSATION DECLARATION t
I hereby affirm under penalty of perjury one of the following declarations:
(�.) I have avid 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 Policy No.
STAM tt=imp— 1942937-0
"(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' compel sation provisions,of Section 3700 of the Labor
Code, I shall forthwith comply with thoselprovisions.
Date: 7"\, rf Applicant-' 1:, , ( r •.�:..
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 hisr,g
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 herebyauthorize representatives of this City to enter upon j.
the above-mentioned props jy for Inspection purposes, H'
Signature (Owner/Agent)k-11 (- .ds* ,' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ��, TRACT
JOB SITE
APN
ADDRESS
5,1. 64:5 .FaVRAWA YALMUO
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C,��}}RCINEL,�1��r"�J��++1ij9l�E��dy.i�:�yC�"y�i�i«ayCDty~�ye+y�
rq
r.�8— 1. so f,i�.V�1K:r �.i8"]�t.R.S LF:e'tA NUIT2i*250
a��.'��R(�r3y�,��.�fw�C��MMIZpL�i•'�C�'!`f.��3,`�wyaftr�q
.P8-3 50 4r+4?iJlJ.Yf+ 2A'SiY:FL ICO !�X1 S. +' 230
u. Q•tM, A CA 92253
U. Qt i,`N rA CA 92253
4-1604 MIX 2261
USE OF PERMIT
1G q� yy +
,kl6tY.1.71,u�.FAMl Y d,1Ctl�'�l�+C.IsSii'0,
'
303 - PER,141:1' rK)H3'NrjT INC,@IDE k,E,C)'L'1 ' OR.
.i3.P}?1iCaM31 DRIVEWAY MAStBR si,•1 o3 CCmi.
T,i1.ACT CC7NST13.L►CTION 1,421.00 SP
P%?.mi/pA:1'To 36.0 Brif
GA➢1.AW(ARYORT (8F) A14?16100
51r"i. WOOD i' .1I.N1.3i.9 2N. (to LF
VERMTpra
COM FEE 101-0W-4.18-,000
PI A414 CHECK FEW 101-£100-439-318 $500.12
MECHANIC'AI., PER 101-000.4211.100 $69,00
WLT,lRYCA10 K01E 101-000-4M-000 5119.44
PUDIMO TMER 101-000-419-000 $11005
STRONO F!i'OT1SY 1TE • .i ESID 101 -oaf? -241, -000 $5.93
4t ,.i3mia%'3i;z 1014=423.000 520,00
DMI.OPERIMPACT FEC $49107,00
PREC-189 MAN 103-000-441-34$ 3 5140,00
YiXL DE POSIT �� � 101-0004-39-318 •84517.00
�
•
h
SV
5.
. ''
-TOTAL r C? i"ttti'C: i. d' AZt o t�Jf i3 c} I .
r
$3,430.74.
LEI Ti PRE -PAID PM
4250.00
TOTAL PERM ISS DDE NOW
,•$
RECEIPT
DATE '
BY %
D E INALED
INSPECTOR
14:,
.<Ir
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footingsp-B�
_�
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
?is -0<
5
Exhaust Fans
O.K. to Wrap
i�_� t
_
F.A.U.
Framing
- y'O t'
7�
Compressor
Insulation
,�
(
`j�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
O(
5
Drywall - Int. Lath
=g
Final
_
_
�'�
Final
41-1--1 O
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
3(L 3
G�7
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
5
Heater Final
Water Piping
_(
Y��IB
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
[�i 3�
�7
Pool Cover
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
Final
Utility Notice (Perm)
Building
Address
Owner
Mailing 1
\ Address
i Cit.
�Contractor
Address
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
City
D
•4 4 "
P.O. BOX 1504
LA QUINTACCALIFORNIA 92253
111
clk'�,-'S3 1 5L\A '
IZI 1 3 ITel.s+;,4 —\f t( ;
City
Lic.#
Tel.
Zip State
Lic. #
I hereby affirm that I am licensed under provisions of Chapfer 9 (commencing with Section
7000) ofDivision 3 of the.BusIIs and Professions Coder and my license is I II force and
effect.( i . 'f ! i I' E / 1 A !i .7 :t / %�% x f/!
1. OWNER -BUILDER 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 e
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 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.)
I I 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.)
I 7 I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm 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
n Copy is filed with the city. O 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 ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. 1
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of adplicant Date
Mailing Address
City, State, Zip
!� WHITE = FINANCE YELLO
APPLICATION O Y
�'t S
BUILDING: TYPE'CONST. OCC. GRP.`
A.P. Number / --I`-�� f`, aO
\ ` d I -- 1
Legal Description�c:�' b,'Amy_(,—\4,
Project Description ., 1• e._X _r M..� :. `c- •e
P_ A _
New
1-k ` 7 � O. j No. Dw.
\ ,$tories 1 Units
Alter ❑ Repair ❑
r -
Demolition ❑
A s t
z.
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
7
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 INSPECTORS e
Issued by: Date F er"rAtt r j
r
Validated by: FLE3 0 a
Validation: 2�
r,.• N r1epG wy Y w v
1
=
W
APPLICANT, -----.,,PINK = BUILDING DIVISION
r 4 _
Desert Sands.Unified School District
r' 47-950 Dune Palms Road
Notice: La Quinta; CA 92253
Document•Cannot Be Duplicated.- 760-771-8515:
- CERTIFICATE .OF COMPLIANCE
Date 3/16/01 APN# 773-131-018
No. 21768 Jurisdiction La Quinta
Owner NameCoronel Construction Permit #0103-004
No. 51-645 Street Avenida -Vallejo Log #
city Li Quint Zip 92253 Study Area
Tract # Lot # 6 Square Footage 1421
Type of Development Single Family Residence No. of Units 1 `
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:
EXEMPTIONNNOT APPLICABLE
This certifies that school facility fees imposed pursuant to -Government Code 53080 in the amount of
2.05 X 1,421 or $ 2,913.05 the property listed above and that=building;,.,,
permits and/or Certificates of Occupancy for this'square footage•in this proposed project may,nowbe issued ,
Fees Paid By CC / Valle Independent Bank - Ahazan Coronel Y` y
y Y p Y Telephone- 7E0=564-4604
'Name on the check /
By Dr., Doris Wilson
Superintendent
Fee collected /exe ted by, Annette Barlow Payment Received , $2,913.05
Check No. 242856
Signature
f�n� .
10TICE: Pursuant of Assembly 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
bove will begin to run from the 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
ollect them on the Distriot('s)(s) behalf, whichever is earlier.l4
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'
9
1 t '
Fidelity National Title. Company
72171 Highway 111 Suite 201 • Palm Desert, CA 92260
(760) 776-5770 • FAX (760) 779-0394
SALE.,ESCROW INSTRUCTIONS-.
Date:. January 5, 2001:
Escrow No.: 42151 -CB
Escrow Officer: Cathy Boyd.
Buyer(s) will deposit with escrow.an initial., deposit in the amount of $ 11000.:00
Prior to the close of escrow, Buyer will .hand you the balance of down payment
(plus closing costs, if applicable) the sum of `......... $ 22,500.00
TOTAL CONSIDERATION ..:...... ................... ..... $ 23,500.00 .
AND, on or before February 16, 2001, Escrow Holder will be handed additional funds and/or
instruments required to. enable Escrow Holder to comply with. these instructions, which Escrow Holder
is instructed to use when ina position to: procure/issue a CLTA Standard Policy -) 990 Form coverage
form Policy of Title Insurance from Chicago Title. Insurance. Company with a liability of $23,500.00,
covering the following described property located in the City of La Quinta; County,ofRiverside, State
of California:. '
Lot 6, Block 54 of Santa Carmelita at Vale La Quinta, Unit #5 -,as per map recorded in Book 18, Page..
63 of Maps, in the Office of the County Recorder of said County.
SELLER/TRANSFEROR STATES THAT PROPERTY ADDRESS IS:
APN #773-131-018-1, La Quinta, CA 92253.
SHOWING TITLE VESTED IN:
5 7-/- 6 Y-5-4 vE,� i bA V� 4Lr-30
Coronel Enterprise, Inc., a California corporation.
FREE FROM ENCUMBRANCES EXCEPT:
1. -Current general and. special. taxes for the fiscal year in which this escrow closes, and taxes for the
ensuing year, if any, alien not yet due and payable;
2. . The lien of supplemental taxes, if any, assessed pursuant to the .provisions of Chapter 3.5
(commencing with Section 75) of the Revenue and. Taxation Code of -the State of California;.
3. Bonds and Assessments with no delinquent payments, if' any
4. Covenants, conditions restrictions, reservatio
any; ns; easements and rights of way now of record, if
PRORATIONS:
Prorate as of Close of Escrow, on the basis of a 30 day month:
-Taxes
CONSUMMATION of this escrow is CONTINGENT UPON THE FOLLOWING:
ADDITIONALINSTRUCTIONS:
1 • PREUM APPROVAL: This escrow and buyer's and seller's obligationsherein are contingent upon
the buyer's approval of the items in the preliminary report, _ to. which buyer's title will be:
subject,
within 5 calendar days of buyer's receipt thereof, sent by certified mail, return receipt requested:
In the event the preliminary report is, personally delivered,, a return receipt. 'hall'be requested. "If:
written disapproval of any matter is not delivered to escrow holder within the time specified above,..
then all such matters shall be deemed approved. and this contingency satisfied'.:.' "
2. CLOSING COSTS: Contrary to the printed portion of these instructions above the buyers and
sellers sig nature. lines, buyer herein agrees to pay the sellers Escrow fee and Owners Policy of Title
Insurance issued by Chicago Title Company,
and County Documentary Transfer Tax:
3. NATURAL HAZARD DISCLOSURE: Seller herei
Disclosure covering subjectn agrees .to provide to buyer. a Natural Hazard
property. Escrow holder is authorized and instructed to charge the
sellers account for same at the close of this escrow.
4. REAL ESTATE CONTRACT IN ESCROW: The parties hereto acknowledge��tyyhat they have
Continued on following -page
Initials:
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, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the;applicant.. It shall be transmitted to the Building and Safety Department as your
correction list: Please attach additional, explanations as.necessary. {
i
.Coronel Construction
APPLICANT J
51-645. Avenida•Vallejo
SITE ADDRESS e
'APN -773 - 131 o 18 BINNO.: CASE NO..:,, 2001-409
LEGAL: LOT 6 BLOCK 54 ' i ' .UNIT S.C.@V.L.Q.
CHECKED BY:' ,Greg .Trousdell 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 ITEM
Y ,
N
,COMMENT/CORRECTION
Compatibility Review "
o
Case logged and number assigned -
,Verify legal and APN information
.O l
Consistent with MDG on file (as'applicable'
boll
MDG filing required (5 flings since 9/3/98)
Consistency with street/surrounding area:
Y l
CoIo
�
Y
o o - Materials\
a�5
ase
0 .
'N1oCpll
�
�5
^
5
`
Jl `� I
. chitecture
_
Other Requirements:
s
er iof,t fica to
a
CityLa'Quintaof
Building and Safety Departmento:Fti
.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: 51-645 AVENIDA VALLEJO
Use Classification: SFD Bldg. Permit No.: 0103-004 ;
Occupancy Group., R 3 ,Type of Construction: VN Land Use Zone: RC
'Owner of,Building: CORONEL-CONSTRUCTION Address: '78-150 CALLE TAMPICO #230'
City: LA QUINTA, CA '92253
L. By: 'STEVE TRAXEL
dr Date: 07-17-01
` Building Official
POST IN A CONSPICUOUS PLACE
_.