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9810-052 (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 634981 B 1/3i/00 Zae f r r , 7 - Z "' 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. (y) 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. 4. WLI) �+ BACIS RX301 23' 1 , 2'1.3 .00 (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 Sectionr3700 of the -Labor Code I.shall forthwith comply wl h.th\ose provisions, r Applicanty �• ( w 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 of this City to enter upon theabove-mentioned property for inspection p`urposes. bSignature (Owner/Agent) ` "� Date�/1,") PERMIT# BUILDING PERMIT DATE gZt2"g VALUATION $84,077.30 LOT 19 TRACT BLK.191116 JOB SITE ADDRESS SUN AVENIDA VALLI+�1O APN , 73.293.005 OWNER CONTRACTOR/DESIGNER/ENGINEER r FSEQ1iJ1EL CORONEL, COP.ON.EL C0 N;;',"€ UC°1'1©N 514-40 i;ISENk10VllEK DR. 5.1-540 EISEN1- OWER DR. LA QU1NTA CA 922.53 L.A. QUINT.A CA 92253 ('760)r 5M -46W C0L#, 22151 USE OF PERMIT Sitdt LF. HAh115' DW :•i..i INN l PX -D - P1•~1t) RT NOT 1NC;1. UDE BLOCK WAILS OR KpiXl. '17tAty T' CONS'IRUCTIO:N 1,279.00 SF 1'01WIli1IA'1IO 0.0 SF 0ARAtiMA1YtJ.l T /.5'39.011 SF R.LOM WALL (M7LJ,-) 216.50 6 Fr, WOW F PKCIE 180.00 LE i=T OF CONSITRUC710N, 33,077.30 PKMT F RE SUMMARY CIONS'i'1:tue. r1;ON FE E 101-000-4.18-000 350.5+1 101-000,439-3.13 �c°T ANIL:AL 1'�k�^ 101-000-421-000 553.30 EC7MICA , FU7 1.01-000.420-000 N1111?b4MNO 1"IFF,. 01.-000-41040 , S127.50 STRONO MOT101 VUE - M-30 a 10,1-000-241-000 $8.3.1 GRADING FMpp� lot -0 0-423-OOv $2t}.��€r Iid�AS'1RifCf'U121:1FHE 225.00013-342 41lW,32 PRI -701 VL.AT+f � lUJ-OtTO-Ai?,1�34"+ Sl.l1t).itc) PI. 1 4 m. CON19TRUC TION ANNP P1,� N C".Fi�:C $1.2745.96 DESS PRT-MT3R7ES vY I?tt",!?ilbt.(.'I' F1<=.'E'S DUE NOW U026.96, . RECEIPT DATE BY y `" DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR ` BUILDING APPROVALS 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 _ Q Compressor Insulation ^—Q T_ 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 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 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 Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS 77 Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels r Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 12/28/98 APN # 773-293-005 No. 18173 Jurisdiction La Quinta Owner NameEsequiel Coronel Permit # No. 52-600 Street Avenida Vallejo _ City La Quinta zip 92253 Tract # Lot # Square Footage Type of Development Single Family Residence Comments Log # Study Area 1,279 No. of Units 1 • ti 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 1,279 or $ 2,468.47 the property listed above and diet 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/Coronel'Construction Y Telephone 56_44604, Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature Juanita Green Payment Received $2,468.47 Check No. 177168 NOTICE: Pursuant of Asse y 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 fro a dale 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') 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 SALE ESCROW INSTRUCTIONS Y 5S, • r T , ' 1• }..y ,fir THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS - READ IT CAREFULLY! TO COMMONWEALTH LAND TITLE COMPANY Escrow No.: 98.7810KC 72855 Fred Waring Dr. Date: 07/21/98 Suite A5 Page: 1 Palm•Desert, CA 52260 (760) 836-3726 Escrow Officer: Kelly Collier THE ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED' " BY THE CALIFORNIA DEPARTMENT OF INSURANCE. Buyer, or his agent, will hand you or cause to be handed you upon signing of " 4 f these instructions a deposit in the amount of..... ...... .. .........E .500:1 ...... .. .. Buyer will hand you.additional funds prior to closing in the amount of..........E 7 5OO,t TOTAL CONSIDERATION E {87i'o0 .�. and any additional funds and instruments required from me to enable you to comply with these instructions, which you are to use on or before August 20, 1998,.and when CHICAGO TITLE,COMPAN' can issue a Standard Policy of Title Insurance Owners form, with liability of $8,000.00.,.on re property in City of LA QUINTA," County of Riverside, State of CALIFORNIA viz: a{. Commonly known as- APN 773-293-005, LA QUINTA, CALIFORNIA 92253 ;{ LOT 19, BLOCK 152, UNIT NO. 16, SANTA CARMELITA AT VALE LA QUINTA, AS " _ PER MAP RECORDED IN BOOK 18, PAGE 99, OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA r.. Except any reservations of record of minerals, oil, gas-, water, carbons and hydrocarbons.-," .showing title vested in: ESEQUTEL M.:CORONEL, A SINGLE MAN .., F(oe .from encumbrance except: A. Current general and special taxes for the fiscal year in which this escrow closes, -and taxes for the ensuing year, if any, a lien not yet due or -payable. ,B. 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. C, Special improvement assessments, if any. D. Easements, rights, rights of way, covenants, conditions, restrictions and reservations record. • i -ems .. hi 4 { 'Sel l er Buyer 'i ERS COPY t