0103-006 (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
Pfofes'sionals Code, and my License. is in full force andjeffect.
'License # Lic. Class Exp. Date
Date �i, ;: 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 thireason
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
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.
(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' compensatiori laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: .F _ 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 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
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)* i _ _ -. f x Date ,Z r.r .•,1
BUILDING PERMIT PERMIT# -
DATE VALUATION LOT (��l� Qaj TRACT
4
JOB SITE
APN
ADDRESS
&71-0", AVEMAVALWO
774-212-015
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
78.150
'!8.150 CAUXTPMPICO BM0.250
UP% QUINTIlk d uA 92253
1A QUWVP CA 922-53
(760)564.46041 M�f. 2261
USE OF PERMIT
ENGLE RM MY DWELUNG
wKA) -1 EMI f' .IriOR S 3sfiOT INC1, 17 ULOCK''W.AJ LA3G'Q.LA, PA OR,
APP ROACH 1 DR6tlJ WA't' MAS IM 3-19� COME'
TRACT CON'ST R,Ut:'t, ION 1,421.00 $F
P(MCM/fo'ATIO 36.00 V
0AtAWKICARPOR (811) 911.90
57r. 'WOOD "NCE 100.00 LF
d^ JRNM+l E,D c®A`Il''OX' C 0WSMC11110M
MNi3i"Rt3M'DON PES 101-000-416-000
PLAN, CHECK lsn 101.000-439-318 $123..03
MECHANICAL = 101-000-421-000 00.421.000 "0100
13",CTRI'CA L WE 101-000-420-0W $129..40
PLUM1 INO RE 101.000.419-000 W0.73
3'1'If.OND ULMON F�J'.;. • R.F.510 101-000-241-000 $8.93
ITRADk1^ O FUM 107.000423.030 $20,00
DWE$wOP411 1KP,s9.M Fes. 31,9(a.90
PKEVIR'i' AX 101.000.441-345 $IK6.0
FEE DEPOSIT 101-000-439-318 4250.00
t �a•
/ OL�6'R'LARptlJPfiNCyECK
ME -TOTAL
@ :'m5.6 .5
- ^ t �'M PTIMT P'�8 DITE NOW
0XIMM
RF(-,FIPT
DATE f 1
>Bf' " _
DAT I gp
INSPECTOR ,.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings�/��j'7
_
Underground Ducts
Ducts .
Slab Grade
/
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap-lS
_��Q�
-�
_
F.A.U.
Framing
Insulation
`% �la%(��
�7
Compressor
Vents
Fireplace P.L.
(
Grills
Fireplage T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
/ _� l
5
Final '
POOLS - SPAS
- BLOCKWALL A PROVALS
Steel
Set Backs
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
�.1i
C
5�
Heater Final
Water Piping
�Zi
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
t�� O 7
S�
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
44,1 _B
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
I
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Building
Address "1
Owne/r -
Mailing fti
Address � (
City `Zip
Contractors
Address , !
City _ \ Zlp
State Lic.
& Classif.
Arch., Engr.,
Designer 1
Address
%\ri=-�;� �+i�r' Fur."'i_.r^::!'� ..b �-}iAxY "�r✓',T'"i�„�r'`=",._-.�...�'M'v'....,.%-.�i�....v ' s. S„ s.%::,".. ��3
P.O. BOX 1504 APPLICATIO NLY
f 78-495 CALLE TAMPICO
U.
LA QUINTA, CALIFORNIA 92253-- -•- .
v
BUILDING: TYPE'CONST. OCC. GRP.
600
A.P. Number_ -1"t-';)Ll-4-6\!S-5
Tel.
Legal Description 'V
Project Description t �,�,M r Mme•
City
Lic. # �� {
Tel.
Ci y Zip State
Lic. #
LICENSED CONTRAFOR'S DECLARATION
hereby affirm that I am licensed undef provisions of Chapt„er.9;(commencing with Section
/7000),of Division 3 of t eBusines"s a/nd�Pr/ofessions Code,,and my licensye is�i force and
OWNER -BUILDER DECLARATION
I hereby affirm that-l
"
am exempt from the Contractor's License Law for the following
reason: (Sec. M31r Business and Professions Code: Any city or county which requires a
permit to construct, alter„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 ($500).
[-JI 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, Buisness 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.)
I'I 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 contractors) licensed pursuant to the Contractor's License Law.)
i 7 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm 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. O 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 (3100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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, after 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 It
1 hereby affirm that there is a construction lending agency tofhe 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.
1 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 applicant Date
Mailing Address
City, State, Zip
11 A � >�
Sq. Ft. `1 1 ` No. ` No. Dw.
Size �'1 Stories Units
New B— + Add El Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. 250 t-"_
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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
t r py
FINAL DATE INSPECTOR ,
Issued by: Date —Permit �
Validated by:
Validation: - n arygq
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District "
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 3/16/01 APN# 774-212-015
No. 21767 1 Jurisdiction La Quinta
Owner NameCoronel Construction
No. 54-095 street Avenida Vallejo
City La Quinta zip 92253
Permit #0103-006
Log #
Study Area
Tract # Lot # 4 Square Footage 1421
Type of Development Single Family Residence No. of Units 1
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,421 or $ 2,913.05 the property listed above and that building -
permits and/or Certificates of Occupancy for this square footage in this proposed project may no�v be issued
Fees Paid By CC / Valley Independent Bank - Ahazany Coronel Telephone 760=564-4604
Name on the check �' !
By Dr. Doris Wilson
Superintendent
Fee collected /exemp d by Annette Barlow
Signature
Payment Received $2,913.05 -
Check No. 242859
NOTICE: Pursuant of Assembly 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 t, 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
ollect them on the District('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
M
i
co
Fidelity National. Title- Company,,
72171 Highway 111 Suite 201 • Palm Desert, CA 92260 Com" "4 •
(760) 776-5770 • FAXA760) 779-0394
SALE ESCROW INSTRUCTIONS-;!.
Date-.* January 5, 2,301
Escrow No.: 42152 -CB
Escrow Officer:` Cathy Boyd
Buyer(s) will deposit with escrow an initial -deposit in the ,amount of ; ........ $ 1,000.00 '
Prior to the close of -escrow, Buyer will hand you the balance of down -'payment
(plus closing costs, if, applicable) the sum of .. .... ' ..... ..... $ 25,.000.00:
TOTAL CONSIDERATION ..... ' ......... ..... $ 26,000.00
•R
AND, on or before February. 16, 2001,. Escrow Holder will. be handed additional funds arrd/or. .
instruments required to.enable Escrow Holder to comply with these instructions, which Escrow Halder
is instructed to use when in a.position to procure/issue a CLTA.Standard Policy - 1990 Form cove.age .
form Policy of Title Insurance from Chicago Title Insurance Company with a liability" of $26,000,00,
covering the following described property located in. the City of -La Quinta, County of Riverside,. Sta1e
of California:
Lot 4, Block 284 of'Santa Carmelita at Vale 1a Quinta, Unit #26, as., per map recorded in Book 20, Page
50 of Maps, in the Office of the County Recorder of.said County.
SELLER/TRANSFEROR STATES'THAT*PROPERTY ADDRESS IS:
APN #774-212-015-5, La Quinta, CA 92253
SHOWING TITLE VESTED IN: '
Coronel Enterprise, Inc., a California Corporation
FREE FROM ENCUMBRANCES EXCEPT:
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RC DISTRICT - PLANNING REVIEW FORM,
This form_ is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential)
District, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT- Coronel Construction
SITE ADDRESS .547095 Avenida Vallejo
APN 7 7 4 - 21,2 - 015 BIN NO.: CASE NO.: 2001-412
LEGAL: LOT 4 BLOCK 284 UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
YIN
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
eyo
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
�a
Consistency with street/surrounding area:
p
toy`
Colors
d
�o��� eQt•
e
�.
a Materials
P.
��a�'
o ,
Architecture
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Other Requirements:
7.7