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0305-262 (SFD)LICENSED CONTRACTOR DECLARATION ;,Il 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, Prof 4'ssionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date.- Signature of ContractorO� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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 pioject (Sec. 7044, Business & Professionals Code). I O I am exempt under Section B&P.C.,fo r 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, is 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 Sbction 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 STATg MD Policy No. 1342039M (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'thl6se provisions. Applicant All"A 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. 'i . - 1. Each person 6pbn 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 thisapplicatioQ,ancl state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, I and hereby authorize representatives'6f this City to .enter upon A the above-mentioned property for inspection purposes. Signature (Owner/Agent) A Date i', A PERMIT# _Bul - LDINGPERMIT (MM -262 _- DATEVALUATION-zz`f9; LOT TRACT ko, 237 is JOB SITE APN ADDRESS s'i_a9*AvFjqWA vpjzwo '774 -IM -MO OWNER CONTRACTOR/DESIGNER/EN (NEER P.D. BOY. 389 .1A Q:UDrTA - CA .92253 USE OF PERMIT FAMILY D WM-JNG 08-9 V.P. SFD PEWIT DOES -Noor , iNCLUDII A9 DRIWWAY-APPROACK CoRown, commuarlow 51- I 05.AVOWA VMLA 410 1 LIA QUDrJ.-A CA 9.2253 (760)364-4604 cBlb 2261 WALt, POOL OR TRACT CONSTRUCTION 1.739,00 SP PORCH/0.01TIO 14.00 SF 0ARAGa4CARPORT 40,00 8F mmATEw cosr of coNsTRuconom, .PERIDMT FEE KThmurzy CONSTRU =01-4 FFIX .10I. -GOO -410-000 $667350 PLAN CHKX FEE 101-000439=318 $553,76 FEE DEPOSIT, 1 01 -000-439:-318 423.0,00 MF,CfW,tICAL FXZ EU CT PJ CAL IME .10140004204000 $121.00 PLUMSTNO FEE $124.00 STRONO MOTION PUB RESTV 101.00IJ-241-000 810170 CRAMIN(I F?_Z . . 101-000-423-000 tism DWELOPER IMPACT FRE $2,405.00. PRECISE PLAN 101-000-441-345 $190.00 SUB,=AL C-bWMUCrnQX AND rILAN 03ROK -PAM'141W LESS PIZE 111071AL F=,Mn YLVSDUENOW SEP 1512003 CITY OF LA QUIWA_ —FINANCE DEPT. RECEIPT DATE BY I I I DAIVINkED INSPECT 74 107,011.30 S4,05S." 4450.00 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Q_ 4al Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck — Exhaust Fans O.IC to Wrap F.A.U. Framing O 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Ptbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Q j Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 6 /! d Encapsulation Gas Piping Gas Test _ v . 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) v 1-7 P O BOX 1504 Building 78-495 CALLE TAMPICO APPLICATION ONLY Address - c„ LA QUINTA, CALIFORNIA 92253 _�IMEA J �F- 4Oc? /¢ C VA&+bo P Owner r, - C', y Mailing G Address Q o 0� City Zip Tel. Contractor��u \ �� Address � Se / Cit Zip Tel. State Lic.L?v , & Classif. v J l C, 1 9 t� City Lic. # Arch., Engr., Designer Address Tel City 11-\ Zip I State Lic. # that I am t Iiccenedun ler provisions of Chapter 91 3 oft Bu i and Professions Fide, and my OWNER -BUILDER DECLARATION I hereby'atilt hat I am exempt from the Contractor's License Law for the following reason: (Sec. 1.5,Business and Professions Code: Any city or county which requires a permit to construct, after, 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 (8500). C] 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,Butsness 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.) r'1, 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.) i7 I am exempt under Sec. B. 8 P.C. for this reason Date .3 Owner WORKERS' COMPENSATION DECLARATION I hereby affirm 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. ❑ 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 thg 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. Date Owner NOTICE TO APPLICANT., If, alter 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 Ihereby 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 if 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 a0plicant Date Mailing Address City, State, Zip LDING: TYPE'CONST.\ OCC. GRP. . Number 1� ` `4a - Q) `0 al Description Uo, \, S-4 -7 Project Description • `- Sq. Ft. ` <n No. \ No. Dw.l Size ` I b ! Stories Units New S Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL WHITE = FINANCE YELLOW = A 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 INSPECTOR Issued by: Date Permit Validated by: Validation: PPLICANT PINK = BUILDING DIVISION r. Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1,789 S.F. or $3,828.46 have been 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. 259169 Name on the check Telephone 760/564.4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature ilvrey Payment Recd $3,828.46 $0.00 , Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this Will serve to notify you that the 9D -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 - Applicant/Receipt Copy - Accounting CERTIFICATE OF COMPLIANCE vsc Desert Sands Unified School District ° 47950 Dune Palms Road z .QBERMUDADUNES r Date 9/15/03 La Quinta CA 92253 f In RANCHO MIRAGE d INDIAN WELLS No. 24958 (760) 771-8515 ALM DESERT PLAQUINT �y . INDIO YYY Y 0 Owner Coronel Enterprise APN # 774-163-010 Address P O Box 389 Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0305-262 Tract # Study Area Type Single Family Residence No. of Units Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 15 53890 Avenida Vallejo 1789 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 patiostwalkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that 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 Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1,789 S.F. or $3,828.46 have been 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. 259169 Name on the check Telephone 760/564.4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature ilvrey Payment Recd $3,828.46 $0.00 , Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this Will serve to notify you that the 9D -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 - Applicant/Receipt Copy - Accounting COMPACTION MOISTURE GENERAL LOCATION: REO.UIREMENTS, % `�v REQUIREMENTS, _•, /> /7 , F READING QUOTIENT/ PCF SOIL 10 NO, TEST DEPTH, IN �_� JCr G7 V_1J 1J • GC). rK MOISTUR CONTENT, I U yZ>b44eU2 i, bj/u..5 //^^% m--7&o-za REPORT OF FIELD COMPACTION TESTS OUR REPORT NO.: 3 PRo,Ecr: S"38 S' NUCLFA,R GAUGE INFORMA nON ANO CAueRnnpw ONLY STANOAAO CAIYAATSON NUM VARIAn0N. PPJICEArr'.. GAUGE ADJUSTMENT COUNTS FROM SHEE7S�5 ; V4FIIATSON FROff Gnu CE TYPc O7C CAMPBELL MOISTURE: MOLSTVA& MOIS'iygf; " - LAST USE MOOEL wo.� 3� .3 DENSITY: DENSITY: MOISTURE: ' TOR i/,hU RMAiION SITS' OENSRY; SOIL 10 tt _ VISUAL CLASSIFICATION OF SOIL. MAX. DRY DENSITY, PCF OPTIMUM MOISTViiE. % COMPACTION MOISTURE GENERAL LOCATION: REO.UIREMENTS, % `�v REQUIREMENTS, _•, /> /7 , F READING QUOTIENT/ PCF SOIL 10 NO, TEST DEPTH, IN ELEVATION OF TEST MOISTUR CONTENT, WET pRY DENSITYDENSITY' PCF DCF PERCENT COMPACTIONCOMMENTS //^^% m--7&o-za �/ 2 3 r4NI1CIAN06 : 4 C/�IFICATIONS 8AA - UC MPLY wRH SPE Z A BACX FILL 0 . COMPACTION PERCENTAGE DOES ROT COMPLY VOTN SPECIFICATIONS 3 BASE COURSE • c RET_STOVOREV10USTEST a suaBASE D - MOISTUAE !N EXCESS OF SPECIFICATIONS 5 SOIL CHMENT . E • MOISTURE BELOW SPECIFICATIONS 6 - orn(R VVHITE-OFFICE YELLOW -INSPECT. PINK -FIELD FILE I- 1- -+ TOTAL PAGE. 03 S.aC iM.fq,'c --s ,- Certificate__of,Oc6 anc 0 o a p Y 14" T-A ; N Lcawoanhn �� OF�w - r Building &, -Safety Department This Certificate is issued pursuant to:the requirements of Section .109' of.: the California' Building= Code, , certifying that, at- the time .-of'issuance,. this. structure 'was in compliance with the provisions of the Building. Code .and the various ordinances of; the ;City, regulating building construction and/or use. BUILDING.ADDRESS: 53-890 AVENIDA VALLEJO ` t Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0305-262 -Occupancy Group: R-3- _ Type, of Construction: VN Land Use Zone: RC Owner of Building: CORONEL ENTERPRISES -; , Add ress:'51-105 AVE NIDA VILLA, #101 _ City, ST, ZIP: LA QUINTA, CA _ By: KIRK KIRKLAND ` Date: April -8, 2004 j Building Official _ x POST IN A CONSPICUOUS PLACE .'"