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9909-395 (SFD)LICENSED CONTRACTOR DECLARATION I hereb>-�ffirm'urider penalty of perjury that I am licensed under provisions of ,10hap4r'9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code; and m_ y License is in full force and effect. License # Lic. Class -Exp. Date' D �� Signature of Contractor )`�`° OWNER -BUILDER DECLARATION I hereby affirm under penalty. of perjury that I am`exemp`t from the Contractor's License Law for the following reason: (. a§,owner. of the property, 'or my employees withwages 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. Jor 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 Section 3700 of the Labor Code, for the performance of the work for which this permit' is issued. My' workers' compensation insurance carrier & pol'icy no. are: Carrier Policy No: Q OLDEN FAME INS NW01A. (This sectlon.need not be completed If the permit valuation Is for $100 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 manne'r.so as to become subject to_the workers' compensation -laws of -California, and'agree that if I ghould become subject to the workers' compensation provisions'of Secti3n 3700 of the Labor Cod -shall forthv�rith compwitF>^ffiose;provisions ,r Date.]^ - Applic nor"'� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000; in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building_and Safety for a permit subject to the conditions and restrictions setforth on his application: 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application'becomes null and void if work is not commenced within 180 days from date of issuance. of such permit, or cessation of,work for 180 days will subject permit.to cancellation. I certify that I have read this'application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction,.avd hereby authorize representatives of this -City to enter upon the above mentioned property f,�r 'fispection puri�:�_S � y Signatur ` (Ow�er`LAgent)r` 1�-'Dat e��� '� f BUILDING PERMIT PERMT# '` F DATE VALUATION LOT rjKilia ISAR T6ACT JOB SITE r RD KESS APN -OWNER CONTRACTOR / DESIGNER / ENGINEER i E;SEQIAL CORt NIff, , .. CORONET. i:C►Ad �RI3 :'�'T13'V St -540 ETSEidHOWTIR D& 55-W EVS04thiO1, ER C, R, CA. QUWA, CA 92253 LA QUINTA - CA 322.53 If GBL# 7.241 ,760).564-X504 USE OF PERMIT W 0. � I' Iv;.7YJ YW 4 d-�II.•{V � - SIM - PER4T DfruS NOT INCLUDE .KO ..K WALL OR FOOL a R13CT CONSTRUCTION 1;405.00 3F POi7OVATIO 49.00 51~ GAAA:�%CARPORT 510.00 SF F -WI" MAX LD COSY OF C+CiWFRUC I ION . 86,939.20 FIERMIT FEE t9UNIAi k -R CC N.T4RUC ION FEE . € 9I dltktD �l l Pl Of5d1 � 1� i .tN7, tf',CAN CHELXIM 1�jr�-4��-3�$ T49I p... . FEF I�D�C;�3I : • ta►�•�W439�-318 4250.00 --1- Ar EC1•I.ANICALYEE 1 1=f1i?d3�12,1,f1 1p $.SO.SO < s r, . . ELECIMCAL M, $122:N 2 �;e. r ���9.T1V1JSINt�3 l�l..E9f�0-41!�-00�i 1ii2�.7a r _ r"• S'I'fit,(3NC3IVIiofil>7N FE..F, - RF51D 101,-000.2414= GRADiNGFEMi(fid. -d2 4fC6- S2G.Os4 . y r,, r D:EVFr..OPF-;R 1,NIPACT F E $1,907.00, � r'. t_j t cIP1.AN101-4113 441�3�i5 4.L%O.�fi Yui .J KrWTMAL CONSTRU '! ION -AND PL AN CHECK $3,413.52 LESS PRE -PAID FEES I L.Vlo OTAX. PERMIT fZEES DUE NO �3g8b3.�2 RECEIPT DATE BYw DA� D �, ^ INSPECTOR r ¢a - 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 F 5 Exhaust Fans O.K. to Wrap _57 F.A.U. Framing _7 Compressor Insulation 12�� / 57, �(— 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 r_��>p �j POOLS -SPAS BLOCKWALL APPROVALS Steel Set Backs /_ ((. �j cv'7 Electric Bond Foptings 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 B1,21 t e- 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 p 9 S Appliances Final COMMENTS: Final Utility Notice (Gas) g'`/� � ELECTRICAL APPROVALS Temp. Power Pole – Q QSz 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) 1 Building `�� Address�-} Owner T-.� Mailing G Address �� n �� \ it City "" ` Zip Vl\ A 11t,t"T C1~ Contractor t"�lr `t�lirl CrrtiC� Address D, f ")'11i'L • Q � QIP 4 CR_ P.O. BOX 1504 l ` APPLICA N 78-495 CALLE TAMPICO W i f) LA QUINTA, CALIFORNIA 92253 State Lic. ' City & Classif. .c1CA01 1 Lic. # Designer Address Tel. City IZip I State Lic. # BUILDING: TYPE'CONST. OCC. GRP. A.P. Number 124 x 1l S Q1 Legal Description k t.) 1 Project Description� 11; f Sq. Ft. No. ' Size Stories New l l� Add ❑ Alter ❑ D LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Ihereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5.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 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 contracror(s) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. 8 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. ❑ 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 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. Date Owner NOTICE TO APPLICANT., If, atter 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 I hereby 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. rI 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 applicant —Date— Mailing ateMailing Address City, State, Zip No. Dw.-I Units Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. Q ..w. 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 :r 11 Notice: Document Cannot Be Duplicated Desert Sands Unified School District 47-950 Dune Palms Road, La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 9/30/99 No. 19398. Jurisdiction Owner NameEsequel Coronel No. 54-795 Street Avenida Vallejo APN # 774-301-013 La Quinta Permit # Log 4 City La Quinta zip 92253 Study Area Tract # Lot # Type of Development Single Family Residence Comments Square Footage 1405 No. of Units 1 . 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 1.93 X 1,405 or $ 2,711.65 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/ Hazany Telephone 564-4604 Name on the check = ,. By ' Dr. Doris Wilson Superintendent Fee collected /exempted by Sylvia Carrasco Signature C�v�Bv Payment Received $2,711.65 Check No. 202427 10TICE: 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 bove 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 ollect them on the District('s)(s') behalf, whichever is earlier. �r <.U11VULU1 : rittatAl a CUpy Ut CUu11ty Ur CIIy plan CneCK application Corm to Qlstrlcl( copy IOC all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting --RC District Planning view Form, This formis to be used by CDD staff for review of single family, dwellings in the. RC (Cove Residential) District, in order to determine the applicabitity of compatibility issues or need to require the filing of i Master Design Guidelines by the applicant. It shall be{transmitted to Building•& Safety as your'correctiori list. Please attach,additional explanations as necessary. APPLICANT: ' Coronel Construction. -` PROJECT ADDRESS: ,54-j0'� Avenida Vallejo. APN:: 774-301-013 , LEGAL: LOT' 3 i BLOCK 311 , UNIT 28- , S.C. @ V:.L.Q. . Fred Baker CK'D BY: BIN NO: -. \ CASE NO. 99-96 . CHECK •DATE: Y 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. 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Verify legal and APN ,infor.mation T Consistent with MDG on,file las applicable) , MDG filing required l5+ filings since 9/3/98] - HIBIT r ASE N0. - Consistency-with-street/surrounding area:. -•—�-- " ' Colors i Materials - 1 - Architecture OTHER REQUIREMENTS:, The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist'shall be maintained -in the Building .& Safety. address file:{