9809-120 (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 . r1131/(it)
0atef�"��' tSignature ofContractor
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.
(k/j 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. £v � 2 40 1�
GOLDENGOLDEN�.G.., INS. 13 C�i� fir 100
(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"ompensation laws of California, and agree that i�1-should become
su 'ect to the workers' compensation provisions of Section 3700 of the Labor
Code, I.shall forthwith comply with those, proGisions.
tDate:tl lY �Applicantr 1- e-,_ (';`-'�, `
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 H
& 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 issuances 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
the al'ove-mentioned property for inspection pulrposes.
tSignature (Owner/Ageni) l _ G" C' Date 2.
a
PERMIT # CONTROL #
BUILDING PERMIT
DATE VALUATION $84,a'T32.2.{) LOT 1 i3 TRACT �?
JOB SITE
2- 2{) l elVIl t� ' OdIC4.1�3
APN 7.730.914)"
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ra-QUSII I.. COR:)NE1.
CORONFIL CO'NSTRUC,110N
P.0.130X 389
51-5,101S1SI„N.HOWER 1).R
LAQU1NI-A CA 922.53
LAQU1'NTA CA 92V5.3
�'?#+s7 5u44fi0A t::al'.4 2261
USE OF PERMIT
Z%;FK1 'LR Fr>wWLY MV]PLt,'fNG
%'D - PERMIT DORS 140T INCLUDE BLOCK WALL OR POOL
T1rAcn, MgS11i?UC'C10tq i,312. Sr
F
POS CH/P X10 114.00 SF
e .A1tAGJ1V A1tP0RT 514.00 .*
a
G F11. WOOD FrT4CF1 200.00 .I,F
' {i.�4. A.i[V.EtRTalD OW iiia i'�lriNS A RUC l aM,
ePERiei T FRIE SUMMKRY
C10N+3'i'.K.LIC.'r10v k"tIX 101-()00-418-000
T1, AN CHFc,K FrF, $49'7 16
NI T30iAMCAL FL—E 101-000-421-000 5 3.50
ELECTRICAL Fl`sE 1,014100420-000 S.1?�,fie1
PLUMBNO FEE, 101-000-419-M $133.50
- 8TR,0N0 W9f ON F1X-1tFSM1 101-000-24140 ".nc
ORALING FW, 101-000A2:3-000 i�►.r��a
1NF12A TRUt;1'M&- ME 225-000-4.43-342 S>,829.6 1
PR C-i[SE PLAIN 101.00-441•-345 $15.00
Mr -P DEPOSIT � 1f11-11011-43y-31R-S2��O.f10
J ,§(*TCY+rWL, CONSTRUGr1t)N AND PLAN
Sz,254.07
L M. M -PAID 1±f ES
"$250.00
S3.004.92
10
1
RECEIPT
DATE
BY�
DATE FINALED
INSPECTOR
..1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_/_-
/ �z �
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck(
Exhaust Fans
O.K. to Wrap
- - e
F.A.U.
Framing
Insulation
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
BLOCKWAII I A PROVALS
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
Water Piping
C i'
G7
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- ` f
Encapsulation
Gas Piping
Gas Test
Appliances
vy-
Final
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
t
Final
Utility Notice (Perm) - %�
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 12/28/98
No. 18174
Owner NameEsequiel Coronel Permit #
No. 52-620 Street Avenida Vallejo Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1,312
Type of Development Single Family Residence No. of Units 1
Comments
Desert Sands Unified School District
47-950 Dune Palms Road `
• La Quinta, CA 92253
760-771-8515 •
CERTIFICATE- OF COMPLIANCE •
• APN # 773-293-006
• Jurisdiction La Quinta
Collector: Attach a copy of county or city plan check application form to district'copy for all waivers.
Embossed Original- Building Dept./Applican
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 1,312 or $ 2,532.16 the property listed above and that building�uy
permits and/or Certificates of Occupancy for this square footage in this proposed project may now,6e. issu6d ti,
N
Fees Paid By CC/Valley Independent Bank/Coronel ConstructionTelephone 564-4604 r
Name on the check
By Dr. Doris Wilson r;t•�
L-fr<.•t1l+i.
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,532.16
Signature X11 lif /l/Li r %!, ��l X -J11 -
NOTICE: Pursuant of Asby 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 frdfn
the date on which the building or installation permit for this project is sssued or on which they are paid to the Distrid(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is earlier.
t Copy - Applicant/Receipt Copy -Accounting
4
RECORDING gDUE,STED M.
CVtICA00 TITLE COMPANY COMPANY
98.7811KC 81031983-B ND pip
Lkj
R&
EflBQUtEL, M, COR01110L
5%-640 91590HOWER PAIV8
LJk grIINTA, CALZroRNIA 92253
ANN: 11j,4V4,UU9
GRANT DEED
,52-42,o Ave ✓i4a&- erJo
x;Le undersigned grantor{e) declare(9).
DacumnntAry transfer tax is $8.80
M 0= Computed on full Valva of pro arty ept►veyed, ox
�I ( 11 Computedoraa d11 value legis Ne-, city s and encuforaneee remaining at time'ofnsale.
unincor
PoR A VALUMLE CONSID4RATION, receipt of which ie hereby acknowledged,•
MARY KAY HAMILTON . an unwArried waman
M hereby GWT(S) to
88EQUIEL M, CORONEL, A SIWGL� MAN
the real property in the City of LA QUINTA. County of Riverside, state of California,
dlescribsd as;.
It
I10T IS, BLCIQK MAP RRC= ED2IN BOOK IS' PAG' SANTA9Op MAPS' RECORDS OF RIVERSIDE
OLITA AT VAL1C &A AS
PER
(!0TWTY, CALIFORNIA ,
Bated July 21, 1998
litate of California
' county of " Riveal4 e } S. S... --
on
.fin'%2. 1942y.._.._ --
1 .oexore 1ne.11T r
1.1 or
,
personally appeared
tan
personally )mown to me (or proved to me on
the basis of satl0fa,ctorir evidence) to be
the person(9) whose names) is/are 9ubacribod
to the within instrument and acknowledged to
me that he/ahe/thsy executed the same in
him/her/their authcrimcd Cagacity(ism), and
that by his/her/their sigraturs(a) on the
instrument the psxson(s), or th5 entity upon
b*hall of ahjo tha pereon(a) acted, executed
the instrument
.
wITNES9 myhan ii nl ssa1.
SWnsture
MAIL TAX STATE E S 0: SAM AS ABOVE
r
3
f
m r�
MARY KAY AAMILTOW
M
1
t
seal)