9812-003 (SFD)LICENSED CONTRACTOR DECLARATION ,
I. here -by 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,
I Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date - 1' +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
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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.
(X)° 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.
COLU N EAGLE TNS. NWCA241S7'2Ot1
(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 proyisions.of Section -s700 of the Labor
Code, I shall forthwith comply with those provisions-,
Date: % /- % k'`Applicant/
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 phis
application. w
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, indemnity
& 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
the above-mentioned property for inspection purposes. i(
Signature (Owner/Agent)'• , ; r�'` - -� Date - 7-
BUILDING PERMIT PERMIT981.�3
DATE VALUATION LOT TRACT
I%146 $9.9,413.5019 U22
A
JOB SITE
APN
r
ADDRESS 51.600 r•l�►�,iWWA VAi..�i EJO
7774-12 3-006
,OWNER
CONTRACTOR / DESIGNER / ENGINEER
r7.SL9 .T117_ . CORONEL
COi2.ORfEL C0NS'r.RTJC t0T,!
51-540 EISENHOWER ER DR.
.51••.540 EISENHOWER DR.
1.,A Qt,JlWA CA „)2253
LA (XINTA CA 9223
C760)564-4604 'CHU '2261
USE OF PERMIT
1;�Ttlt,1:; `�.A.i1�1].,� TJiA�.I,1.,lNii•
SFD4i?1t1 UT DOES .NOT NC:LUDE BLOM. OR POOL. COFtOI W.,
MAJ31I`>.,1t .1(1.421 31F )
pSUIUCTIMIN
Poll lirlakifo X00. sr.
fJA1 7 Y A1tkU,l2I' 314.00 3F
61.'T.W000FENCE 100.00 LF
F.&HINTATFED COST OF CONSTRUCTION,
89.413.50
VICIRM IT FEE, SUMAVAXV
C'ONsi:KVCTX)N Pl-,E 101-000-419-000 *59..59
Aro :iAw.rAL fT-.r 101-000-421-000 �51.5fl
1;t.l:c:t'e�lc:m, f"11k, 101-M-47040 123.5:b
PLUMBING FEE' 101-OLW-419-000 $133.50
41TRONn 11166)f'fCj'�tT' : -tzr•; rl(3 ';()t.()tl(�24f 0(1!1 SR u!
OlfkA :iINCH"- E S j 01.000.423.400 Ire0.00
iNFR,AS'VRtJ(s i'Uft,' Ff.ffE 225-00t 443=3412
PRii1_"1;31 .PLAN 101 -WO -441-345
f�7"3; J'a►�1�t1'.�tt"4' (t?l.-1}(}t1-a1;��)-31h' ��4.ig.tuJ
t f-'►'f3Ts, G(?'"1'1' (;f(`1'f�7t� AND Vii. LAN c..���(,pz,424
44
f ESS P -PAW FEES
t. ,.,DOD
1250,00
0 E C 0 3 1998 ""`c �� e.v;s :"ilk' -N w
S3,174.44
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
i6v
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings 4o 12
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck (— '
Exhaust Fans
OX to Wrap
F.A.U.
Framing —Q (-
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
BLOCKWALL AP ROVALS
POOLS - SPAS
steel
Set Backs 4c 4y&Electric
Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 12/2/98
Desert Sands Unified School District.
47-950 Dune Palms Road
La Quinti, CA 92253.
760-771-8515
CERTIFICATE OF COMPLIANCE
No. 18062 Jurisdiction
Owner NameEsequiel Coronel
No. 53-600 Street Avenida Vallejo
_City La Quinta zip 92253
APN # 774-123-006
La Quinta
Permit #
Log #
Study Area
Tract # Lot # Square Footage 1421
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:
r
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 and that building'
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By Cashier's CheckNIB - Esequiel Coronel
Name on the check
By Dr. Doris Wilson
1
Superintendent
Fee collected /exempted by Ellen Patino
Signatur�
Payment Received
Check No.
Telephone,` -5 64-4604 .
'$2r742.53 -
.
177094
40TICE; Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify yourthat 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
:ollecl them on the Dislrict('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
SALE ESCROW INSTRUCTIONS
t
` :THI&DOCUMENT WI LL AFFECT YOUR LEGAL RIGHTS -READ IT CAREFULLY! J., ,
{
=ATO:% COMMONWEALTH •LAND�TITLE..GOMPANY Escrow No.:
�98.7782KCz.� 4K o�
72,855.Fred Waring Dr. Date: 07/15/98,s
Suite A5 Page: 1°
' '-Paxl'm •Desert, CA 92260
'
(7"60);_836-3726 •
`' Escrow• Officer: Kelly Collier
THE'ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WHICH IS LICENSED-'
BY THE :CALIFORNIA DEPARTMENT OF INSURANCE.
44Buyer,,tw �l lohand,y,ou,-addi'ti onal, }funds . pr.ior.. to, closing, in. the amount
TOTAL;CONSIDERATION
$ 12 500 4.0
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 September 14, 1998, and when CHICAGO'TITLE.
COMPANY can issue a Standard Policy of Title Insurance Owners form, with
liability of
•$12;50.0:00, on real property in City of LA QUINTA, County of Riverside,
State of CALIFORNIA-vi,z:
Commonly'knor as: APN.774-123-006=2, LA QUINTA, CALIFORNIA 92253
LOT 19 .;.BLOCK,•230,•UNIT NO. 22, SANTA CARMELITA AT VALE LA QUINTA, AS
` IN BOOK 20, PAGE 24, OF MAPS, RECORDS OF RIVERSIDE
{
:,PER.MAP-;RECORDED
COUNTY 'CALIFORNIA
E=xcept zany res-of.,r.ecord,,of- mi.neral,s ; oil , -gas, ,water., carbons.,
and _hydroca.rbons
• ,,
w F s
,,Sh6wibo. htitl e vested i n :
i
ESEQUIEL M. CORONEL, A SINGLE MAN
y u
Free` ;from encumbrance except:
A -,. 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.
r '
�sSpec al i.mprovement assessments, if any.
D. -I... -Easements, rights, rights of way, covenants, conditions, restrictions and reservation,s.•of
.record
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j , ,. m�Md l•L•
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�i a . .. Vr .. �,�� •• S. X�y
1 'eft' `•i . '.,, w .
. _ � +Fj � �, 4� ,
` Seller Buyer
61.jYESS COPY
a , 2 , r
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+v•!,••w...«r.•.i•••.•.+••e.......�...-.......... .......•.r.—.�...w.�:..w..swryY�..w�n,1{lw+...4-w,.W.
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