0005-036 (SFD)LICENSED CONTRACTOR DECLARATION
I,hereby affirm under penalty of perjury that I am•licensed under provisions of
Chapter 9 (comr)encing with Section 7000) of Division 3 of the Business and
ProfesSionals.Code, and my License is in full force and effect. p
ense # Lic. Class Exp'. Date
634981 B,1' r 01 /31 2C
Date !(4'0 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). f
( ) 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 L'`abor 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 STATE FUND Policy No. 1$42937-00
(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 at' if I should become
subject to the workers' compensation, rovisioWs of - ection 3700 of the Labor
Aode,d-s �'��� allh�witb comply"with t 6se provis-pns.
ate:' `44�Applicant
i 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, 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.aU thorizeP repr�e,ssentatives of this City to enter upon
rtheove-mentioned pro/perty for inspction purposes.!•/ure (Owner/Agent
e° .(Zion "''y Date � 1 � ('
f t
/3 a `BUILDING PERMIT PERMIT#
•
DATE VALUATION LOT ' (XM -; TRACT
$92.692,70 2
JM SITE y•p
ADDRESS N-775 t3VF.NMAVe8ar4.3!;srr0
��1 (✓ V 7 L i
.OWNER
CONTRACTOR / DESIGNER / ENGINEER, _
EaQLIM COROm,
CORONET. CON U11=1CN
V,0. BC}X 3.119
51-540 Mff0-TH0V= DR.
L& Q•UIN'iA CA 92253
LA QUINTA ' CA 922 3
(760)g64.4604 CBLO '2'261
USE OF PERMIT
4811101.E FAMILY DVJRJ J NQ
SPD -PERMIT DOES NOT INCL.UDO BLOCK AL.I.S OR POOL
TRACT CONSTRUCTION 1,485.00 6F
PORCH/PATIO 1 36.00 SIS
0ARA0&fCA.R,POR4' (SI) 9t8'i€i;40
s PT. WOOD IENCB 200,00 L
19ILMX KI) S'OLA'R OF CONS'M`47 MOT4
92,692.70
PERRL.° M SUAWARY
CONS`I RU07ION FEE 101.000.418.000 $608.40
PLAN CIHW% FEE 101-000-430-31$ $507.17 -
j
MECTIANICAL FEE 101.000.1421-000 $53.50 �
VJ,F,CTRIt,A.L FEE 101-000-4.20-000 $125.56
PL,UMBINO IRE 101000.419.000 $no,75
STRONG MOT1014 FEE - RBSID 101-000--24'1-000 $0,77
GRADINOIan 1t;I.000.423.000 $20,00
DEVELOPER IMPACT ME
PRECISE PLAN 101000-441.34.5 $100;04
FEE DEPOSIT 101-000-.439-318 -$250.00
4
SUIS -TOTAL. COAISTRUC iOW AND PLAN CEEMM.
$3,441.23
LIDS •PRE -PAID k"F,Is:3
-$255060
r
RECEIPT —7I
DATE
BY /
DATE F LE
IECEIPT
INSPECTOR
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
Ze —(O —pO
Exhaust Fans
0. K. to Wrap
1.0 - . pe $
F.A.U.
Framing
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 Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
9 S7
Plumbing Final
Plumbing Top Out
y T T
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
J
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)
f 3�
Building ,L� 7 S4\vr-
Address C._
Owner
3
P.O. BOX 1504 APPLIC TI N O Y
78-495 CALLE TAMPICO
('j LA QUINTA, CALIFORNIA 92253 !J 1
Mailing
Address ? o. Sac/
Lnl Zip ^� r Tel. , f
l..!(�.� ( Yul fl-) ck `,, rJ` j i .5matlf/-`—
Contractor
State Lic. City
& Classif. / 11�k L—ta Cn,, I Lic. #
Arch., Engr., I
Designer
Address Tel.
City (Zip (State
�IwLic. #
LICENSED CONTRACTOR'S DECLARATIC
that I am licensed underjg rovisions_f
$�CFtapter 9
3 of theusiness and 1ofessions Code, and my
OWNER -BUILDER DECLARATION
I hereby affl'1r,�m t to I am exempt from the Contractor's License Law for.the followin
reason: (Sec. 70�1.5,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 thealleged 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).
I: 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 1 I, 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.)
1-1 1 am exempt under Sec. ` B. & P.C. for this reason
Date 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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., It, after making this Certificate of Exemption, you should become
subject to theWorkers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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 it 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 stale 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
BUILDING: KPEE'CONST. rO,CC. GARP.
A.P. Number /�� //` +.✓� c y�L4 7, l
Legal Description ��C�U
t 1 K) kT ,;Q
ect Description
4
Sq.Ft. } �(}�t�
size
Size t (/ .f Stories
Stories
No. Dw.
Units
New P1.1, Add O —Alter
epair ❑ Demolition ❑
I�/�IJCP_Y1ClL /s
VTA
MAP0 9nn
Estimated Valuation
Fav a. v
PERMIT
AMOUNT
Plan Chk.
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
t
4
W
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 7/13/00 APN # 774-301-012-7,
No. 20699 Jurisdiction La Quinta
Owner NameEsequiel Coronel ` Permit #
No. 54-775- Street' Avenida Vellejo Log #
City La Quinta Zip 92253 Study Area .
Tract # Lot # , 2 Square`Footage 1485
Type of Development Single Family Residence Ivo. 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:
x EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,485 or $ 3,044.25' the property listed above and that building'y.1'- 4- r
permits and/or Certificates of Occupancy for this'square footage in this proposed project may now be issued —C',,
Fees Paid By cc Valley Independent Bank • Telephone 564-4604
Name on the check
By Dr. Doris Wilson '
Superintendent '
Fee collected /exempted by Sheryl Simmons' - Payment Received a $3,044.25.
0. Check No. 216566 i
Signature +
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
collect 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
.1 al a -o -d 42NALLEJO
' Commonwealth Land Title Company
!
72855 Fred Waring Dr., Suite A5,;Palm Desert,
CA 92260
Buyer's Settlement Statement
Escrow No.: 9485KC
Buyer: CORONEL ENTERPRISES, INC., A
CALIFORNIA CORPORATION
Property: APN �74� 0 011)andDiz
VALLEJO; LA QUINTA,
CALIFORNIA
92253
Escrow Officer: Kelly Collier
Date: 022400 ,
DEBIT
CREDIT
TOTAL CONSIDERATION
Deposits by Buyer
$38,000.00'.
BUYER _
000.00
'38,400.00
PRORATIONS/ADJUSTMENTS
COUNTY TAXES (LOT 1).......... 76.29
02/24/00
07/01/00
53.83
,
127
COUNTY TAXES (LOT 2)...........:.76.29
days @.42383
02/24/00
per.diem
-.07/01/00
53.83
. 127
r
days @.42383
per diem
LENDER CHARGES
ESCROW FEES, TITLE CHARGES
Settlement Charge
150:00
RECORDING FEES, TRANSFER TAXES'
Record Grant Deed
9.00
REFUND DUE BUYER r
2,133.34
•
i
4
.
$40,400.00
,
$40,400.00
RC DISTRICT - PLANNING REVIEW FORM
This form is to be'used by CDD staff for review of single fan -lily 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 54-775 Avenida Vallejo
APN 774 - 301.- - 012 BIN NO.: 10 CASE NO.: 2b 0 0 - 2 01
LEGAL: LOT 2 BLOCK 311 UNIT. 28 S.C.@V.L.Q.
CHECKED BY: Leslie Mouriquand DATE: — g
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
Y
N'
COMMENT/CORRECTION
Compatibility Review
L�
Case logged and number assigned
L�
Verify legal and APN information
Consistent with MDG on file (as -applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
-
Other Requirements:
/
V
%vvcu
; &1UN"y')EM0PMENT DEP
U It
XHIBIT —
0.
7