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0306-442 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of -(C,,hapter 9 (commencing with Section 7000) of Division 3 of the Business and Prof6ssionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 634 981 B Date --n ;Signature of Contractor; r 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. ( ) I have and will maintain workers' compensation insurance, as required by SeEtion 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 S!'Afk, FUND Policy No. " 139x X?.0;1 (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.„l should become subject to the workers' compensation provisions” of Section 3700 of the Labor Code, I shall forthwith comply with athoseitprovislons. � Date: c� Applicant•-f� • ,4 - *- - " . 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 onhis application. 1. Each perpon 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 the above-mentioned property for inspection purposes. Date Sigh'ature (Owner/Agent) %� . .i,F. •fir t�1y,•�•'d �'4 ' �_ yam/ PERMIT # BUIL:DIN,G:�PERMIT 030"42 DATE AC VALUATION LOT_ -: TRT 1 � -7_ l to 3 -00 JOB SITE' ADDRESS 04-1 D AV1!'1IDA VALLFJ0 APN Tas� c d OWNER CONTRACTOR / DESIGNER / ENGINEER 070MML <L1" lr1'C '1�&I;11 Cc"512ONM (10NMIAL1'�,:.` 0111 )P,O. BOX 3 319 - 51.105 AMt)A VW A #101 1..A QUINTA CA. 92253 LAQUI r1TA CA 92253 060)564-4604 CW 2261 USE OF, PERMIT SIWC+LE TeAW. Y Dvmlwo 191 as,F,SIF0 P&Rhf;T DOFS NOT fXCL,U'DF, 'SLOCK WAi l l P001A A OR DRIVEWAY APPROACH TRACT CONSTRUCT101.1 _J,030.00 SF ' PO.RCiilPATIO 19.00 SF CLA'1%ACei1lt,:,,P PORT 4$0.00 SI+' x.`SIE7'Nw:rED C'OL'IC 035' Co1`IsmuC~ on 1,111418M.10 'R.1I' 1n � SUMMRY COMMOTION MY, 101-000.419.000 $05.5.0 PLAN C11WK FEE 1©1-G00-439-311 $569.34 RE DEPOSIT 101.000-439-318 42511.00 MECHA? ICAL.115 $59.90 ELECTRICAL FU 1.(1-,000,.420.000 £125123 PLUMBnla P", 101-0011-.1.19-000 $17A.00 STRONG MOTION " • RMID"' 101,-000-241-000 $4.1.38 GRADING ISE 11Ji 400-42.3-000 $IS.tfO DEVELOPER IMPACT FU SZ,dOS.tti►. PRIZISE PL...N i Q!1-C1aU-4 1.- 4 $100. fli . # RM-TMAL e;`OMIRI]MION AND PI.{3N CHECK U.097.43. LEN H &PAM MS 4250.00 e ' PKi1• f.V'ES ..DUE .WWW 1>4� SEP 151003 CITY OF U QUINTA FINANCE DEPT..`: RECEIPT DATE BY ; ; f DATE • I, A p INSPEG 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 – d Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wali 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 v 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: - - 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobil homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: t EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14X 1,918 S.F. or $4,104.52 havebeen,paid for 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 CC/Valley Independent Bank - Ish Coronel Check No. 259165 Name on the check Telephone 760/564.4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted byShar n MCGllvrey Payment Recd $4,104.52 Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public.entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE:•This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy-ApplicantlReceipt Copy - Accounting -CERTIFICATE OF COMPLIANCE _6FIED Desert Sands Unified School District 47950 DunePalms Road �q�:�o ¢ BERMUDADUNES r Date 9/15/03 La Quinta, CA 92253 C/) RANCHO MIRAGE d INDIAN WELLS No. 24957 (760) 771-8515 PALM �d QUINT �y �INDIO y7 O Owner Coronel Enterprise APN # • 774-165-009 Address P O Box 389 Jurisdiction La Quinta City • La Quinta Zip 92253 Permit # 0306-442 Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 16 53870 Avenida Vallejo .1918 _.Unit 6 Unit 2 Unit 7 ; Unit 3 Unit 8 - Unit 4 . Unit 9 Unit 5 Unit 10 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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobil homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: t EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14X 1,918 S.F. or $4,104.52 havebeen,paid for 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 CC/Valley Independent Bank - Ish Coronel Check No. 259165 Name on the check Telephone 760/564.4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted byShar n MCGllvrey Payment Recd $4,104.52 Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public.entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE:•This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy-ApplicantlReceipt Copy - Accounting I - BASE COORS Q - SUBBASE 5 SOIL CEMENT 6 - OTr.ER EC� n • ION PEACdNTAGE DOES NOT COMPLY WITH SPECIFICATIONS v C • RETEST OF PREVIOUS TEST 0 - MOISTURE IN EXCESS OF SPECIFICATIONS E - MOISTURE BELOW SPECIFICATIONS ✓JHITE•OFFICE YELLOW -INSPECT. PINK•FIELO rILE TO 95644202 P.02/03 REPORT OF FIELD COM PACTI0N TESTS r OUR REPORT NO.: "' 38 7o I/A ",J u .I "IUCLEAR CAUCE INFORMATION ANp CAUBRATIOw OWLY STANDARD' CAIBRATIDN NUMBERS VytWT1oN. PERCENT, -i. FROM SHET �UGE AUIECOUNTS % VAWATION FROG[ , CAUQE TYP . TROX CAMPBELL MOIsruRE: AN USE (�/ MOtMAF: MOISTURE: MODEL NO.: / 90C1" R IwFOnMArlpw DENSITY: DENSITY. OENsrrY: .. OENSrrY: I - BASE COORS Q - SUBBASE 5 SOIL CEMENT 6 - OTr.ER EC� n • ION PEACdNTAGE DOES NOT COMPLY WITH SPECIFICATIONS v C • RETEST OF PREVIOUS TEST 0 - MOISTURE IN EXCESS OF SPECIFICATIONS E - MOISTURE BELOW SPECIFICATIONS ✓JHITE•OFFICE YELLOW -INSPECT. PINK•FIELO rILE 1 Certificateof Occupancy OF �w ; r. .' - :-Buiidin. & Safe Ditmr A g. ty epaent a .This Certificate is:issued pursuant to �the'requirements of Section 109, of the California Building Code,, ;certifying -that,' at the tune of issuance, ,-this,. structure was ,in compliance with: the - :provisions of the -.Building Code `and the, various ordinances of- the City'regulating building. ", t construction and/or' use. BUILDING- ADDRESS: 53-870 AVENIDA VALLEJO F 7 t, Use classification:'SINGLE FAMILY DWELLING _ - Building Permit -.No.: 0306442 , ;Occupancy Group.'R-3 Type of. Construction: VN ;- . Land .Use Zone:•RC' FG Owner of -Building.: CORONEL•ENTERPRISES• Address: 51-106 AVENIDA VILLA,4101 ,. City,L ST, ZIP: LA QUINTA, CA' , By: KIRK KIRKLAND . Date:April-8,2004 'Building Official./,-'. 'POST IN A CONSPICUOUS PLACE