0209-125 (SFD)LICENSED CONTRACTOR DECLARATION
1, hereby affirm under penalty of perjury that I am licensed under provisions of
'%hapter 9'(commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class r ExptDate f /
6349-81
04
f
,D'ate 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
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 b')'EN F°UND Policy No. 1$42937,01
(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 I should become
subject to the workers' compensation provisions of Sect on'3700 of the Labor
Code, I shall forthwith comply with thosel provisions. '
Date: --- t: - 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.
is: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 voidlif '
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 fortinspection purposes
Signature (Owner/Agent).�? .� ; .� � Date _EL, -�•�
BUILDING PERMIT PERMI0200
41,ti
DATE �VALUATION Viqmi1• _v LOT 14 TRACT BTA' 2
�� F F/ 'S!t••ef
JOB SITE
ADDRESS .lL-45g �,°i LT& Jxb'4>!vA.tii', IM
APN
OWNEERryq�
CONTRACTOR /, DESIGNER 1NEyER
q�yryy }.7+ {7y�pyry
tr'k:dli�(.LY� iw °i J.i�+¢'i.C'�Jd.T��fj
y/EN
5..4J.C�SlA�7."^.w L4L.�.LNi�3,�7.t./� {��•�
PORWX 389
78-150 CAI:,I.. T' ,�' l70 M`erYWE: -23..0
LA QId;1x�T r.k CA 92253
9225.E
USE OF PERMIT
1403 s.Y:.5b. PSAMIT DOM"NOT YNC'.l.,UOK BfXi(:Ye.'4 ALL' , Pool.. OR
DRixlr lAY AP'f ROAC'.R 7:��}de I3.E1:JI3M MIR, FOR MU t Il'M-31 PIAN GSI WU
$AW417, T'YPX
'TRACT COTtS7'A CTICN 1160.0.00 Sit
PORC1'.Ip'A'i;IO 90,00 SIS'
}
GA.i3li3OEXAtdPt"3U 463.00 O
VF -M it -re EVE ST MMMY
i
C-014MUCT104- ITZ 101400.416.000 9630,50
t
Iad,,Akt' CHECK, fir: 101-000-429.118 $430,4
M, DEPOSIT 42%0
MIECHANICAL MV, $5150
ELECTRICAL,FEE 101400-420-000 241.3,04
PJAJI1 DIN0$Ia.fla
!0.74
ORAD31,101F,t�i
PRECIM P1. AH 101 >'60( 41-134-a M00.00
t.:;
:tM4DMC014M'I; MUOt>YAM) PLAIT r-TIFXXii.1
S
LOS PRE -PAW T:Iwv
•
1�A1
4250.1)0
k :X,7rS'OIYI:.A.EMM& DL IK BO
"i.la. Tpv Ar.7: Li
SEP 2 0 2002
CITYOFLAQUINTA
RMCEDEPT- l6.
RECEIPT
DATEy
.. % ! /'
BY
.sem., �
D FINALED
INSPECT
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 tz -15.0 - O
F.A.U.
Framing —Z
Compressor
Insulation
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final�2 j'�J3
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
Gas Test -
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power - p
Final
Utility Notice (Perm)
Building �\ a
Address
Owner- \
r
Mailing
Address
City
Contractor ,
Address
Zip Tel
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
City Zip Tel.
State Lic. City
& Classif. w4 f , ` Lic. # {
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
- -, Lic. #
LICENSED CONTRACTOR'S DECLARATION
I
here byy affirm that I am licensed ddei provisions of Chapter 9 (commencing with Section
7000),orDivision 3 of the/'BussineSs and°Professions Code, and my license is inrfull forcb a d }
eifec 1. �• tet! j �f,•-�. ��i
SIGNATURE Y ` - re_�",� DATE
POWNER•BI1 CI7ER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.(703U5,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 live 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 11, as owner of the properly, 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.)
I'! I 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
C7) 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, 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
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 applicant Date
'Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number 7 - t `t
Legal Description
Project Description
Sq. Ft.
Size
New -O
No. t
t S Stories i
Add ❑ Alter ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
No. Dw.
Units
Repair ❑ Demolition ❑
AMOUNT
jf IA_
11 L11
IATA
PT.
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
CERTIFICATE OF COMPLIANCE JFsc
Desert Sands Unified School District ��I � �o
47950 Dune Palms Road z o
Q BERMUDA DUNES r
Date 9/19/02 La Quinta, CA 92253 Cn RANCHO MIRAGE
No. 23635 (760) 771-8515 ted INDIANwELLs
PALM DESERT ,y
LA QUINTA
10-
1t 0IO yJ
Owner
Coronel Enterprises
APN # 770-166-011
Address
Jurisdiction La Quinta
City
La Quinta Zip 92253
Permit #
Tract #
Study Area
Type.
Single Family Residence
No. of Units 1
Lot # No. Street S.F.
Lot # No. Street S.F.
Unit 1 14
51450 Calle Jacumba 1605
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 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 1,605 S.F. or $3,434.70 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/ VIB - Ish COmel Check No. 264997
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,434.70 $o.00
Payment Recd Over/Under
Signature M11VA
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 - Applicant/Receipt Copy -Accounting
Z/ .50 �I-L 4�` &A7
111Ut1RECORDING REQUESTED Br:
TIDE ESCROW SOURCE, INC.
AND WHEN RECORDED MAIL TO:
AND MAIL TAX STATEMENT TO:
CORNELL ENTMRJSES, INC.
Order No.
Escrow No. 02.3276 -SA
Parcel No. 770-166-011-1
GRANT DEED
THE UNDERSIGNED GRANTORS) DECLARE(S) THAT. DOCUMENTARY TRANSFER TAX IS 545.10 and CITY $
X computed on full value of property conveyed, or:
computed on full value less liens or encumbrances remaining at the.time of sale.
unincorporated area: X La Quinta and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
SCOTT A. CHARITON and JEAN CHARITON, Husband and Wife as Joint 'Tenants
hereby GRANTS to CORNELL ENTERPRISES, INC.,
the following described real property. In the County of RIVERSIDE, State of California:
PARCEL NUSER 770-166-011-1
LOT 14 OF BLOCK 7 OF UNIT 2 OF DESERT CLUB TRACT AS PER TNIAP RECORDED IN BOOK 20, PAGE 6 OF
MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF RIVERSIDE COUNTY.
Date July 16, 2002
SCOTT A. CHARITON
STATE OF CALIFORNIA
JEAN CHARITON
) S.S.
COUNTY OF )
On , before me, the undersigned, a Notary Public in and for said County and State,
namnnaliv anoeared SCOTT A. CHARITON and JEAN CHARITON
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names) is/are
subscribed. to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized.capaclty(les), and that by hislher/thelr'slgnature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the Instrument.
WITNESS. my hand and: official seal.
Signature.
I 'd C8971'ON S831C89 'dWd NVE1 6 '0000 'fi;' I11f
BUYER/BORROWER STATEMENT
Final
Escrow Number: 02-3276-SA Title Order Number: R-212819-1
Escrow Officer: SANDRA L. ARLISS Date: 08/24/2002
Closing Date: 08/22/2002
Buyer/Borrower: THOMAS BUFFIN
Seller: SCOTT A. CHARITON and JEAN CHARITON
Property: APN: 770-166-011-1, La Quinta, CA 92253
" x S` RI'4Tvs
«.ii�,9i..a I!'tWs.J4k:.s"Y,+, . !%.4droFs'.','rt�
TOTAL CONSIDERATION
Initial Deposit
Additional Deposit
TITLE CHARGES
County Transfer Tax: ORANGE COAST TITLE
Owner's Premium for 40,000.00: ORANGE COAST TITLE
Binder Fee for 40,000.00: ORANGE COAST TITLE
Mortgage Recording Fee: ORANGE COAST TITLE
Deed Recording Fee: ORANGE COAST TITLE
Lender/Mortgagee Premium for 40,000.00: ORANGE COAST TITLE
ESCROW CHARGES TO: THE ESCROW SOURCE, INC.
ESCROW FEE
LENDER CHARGES ..
New Note/Deed of Trust to PACIFIC MORTGAGE EXCHANGE:
ADDITIONAL DISBURSEMENTS:
Natural Hazard Report Fee: PROFESSIONAL HAZARD DISCLOSURE
BALANCE DUE TO.ESCROW
TOTALS
1,000.00
644.90
44.00
400.00
60.00
27.00
17.00
1,027.00
250.00
40,000.00
47.95
228.05
41,872.951 41,872.95
, v I------ - I . VL/ VG
-P =.TbBui1d0n
Info m Pion
Eng0jeeflng • CgnsrrJtD>Ig • reW" .
REPOR" OF FIELD COMPACTION TESTS
TESTED FOR: CORONBL CONSTRUCTION PROJECT: 51-450 CALLS J'ACt7MBA
PO BOX 389 LA QUn-rrA, CA
LA QUINTA, CA .92253
DATE: November 05, 2002 OUR REPORT NO,; 073-20298-2
TESTDATA: (1) Medium to coarse grained silty sand OPT. MOYST. A 13.0%
TEST LOCATION: Building pad.
L—L ucorner
NW corner
SE corner
SW corner
nV 1 CS i.7 rCRV VRM D PUK ASTM OZ!= -90 8 ASTM 09017.96 *COMMENTS: 1. FILL TERIAL A TEST RESULTS COOLY WITH SPECIIF�GiiT1gN5
D NSITIES SIIO Ws. nercuWc foot 2 BACKFI B. PERCF�fT C MPACTtON DOES NOT C(yM1P��`
A151 CONT ttie tit otatryy weht- s: BARE C tJRSe WITH SPECI�ICATCONS
PERGt MPACT101d: ud dry d. SUBBASE C. RETEST pF US TEST
o0tained o ssmple�n up oy 5- SppI &CEMEN7 D. MOISTURE �gS OF SAE�IFICATIONS
39 "u 6.01 H�I2 E. MOl PECIF LCAT ONS
* (1) ASTM D1557-00 METHOD A
TEST INSTRUMENT_
REMARKS: PSI did not monitor the material placement_
o Flood plain location.
95V compaction required.
TP-CHNICIAN- Vinnia De- Souza
TM6SE TEST RESULTSlW�LY pM.Y rp 1» 9ECv[C LOCA�IOrq MCR'O •W rwr nod 4�v: rt(i♦:N'r MI'I OTI�R t.Ots�T,ONB OR ELEvwYIONb.
KC"ft WAY NCR OY REAA001iM. EXCEPT IN Wll. Wr,10U1 VMWr8N oeasAss 0H BY %RCFEWI, N INOU6ME& M.
STANDARD COUNT M: 0:
ADJUSTMENT DATA M: D:
Respectfully submitted,
Professional Service Industries, Inc.
PCA --00.2 RIF Prof8S610M1 SWQe WuSVW, IIIC. • 42.240 Green INay, SUR, C . Palm Desert. CA 82211 • Phone i6tN341-5790 • Fax 76OM41-5794
Z ' d 098' ON HOO z Przooa ' V ' 08ak*
NoY
5
D6TM
SO+LIO
MAXIMUM
LAB DRY tt
WATER
WvEt
DRY
PER
COMMiNTS•
Spec 9.5% Min
ELEVATION
NUMBER
DENSITY
CONTENT
DZMITY
118.4
01IN61TY
112.7
COMPACTioN
.
3.
8"
.8°
F4
FG
1
1
116.0
116.0
5.1
97.2
1 _ A
2
4.6
117.0
111-9
96-5
1 - A
1 - A
3
8''
8
FG
FG
1
]
116.0
116.0
41B
117.9
112.5
97.0
:4:::]'
5.4
118.3
112.2
96.7
1 - A
TEST LOCATION: Building pad.
L—L ucorner
NW corner
SE corner
SW corner
nV 1 CS i.7 rCRV VRM D PUK ASTM OZ!= -90 8 ASTM 09017.96 *COMMENTS: 1. FILL TERIAL A TEST RESULTS COOLY WITH SPECIIF�GiiT1gN5
D NSITIES SIIO Ws. nercuWc foot 2 BACKFI B. PERCF�fT C MPACTtON DOES NOT C(yM1P��`
A151 CONT ttie tit otatryy weht- s: BARE C tJRSe WITH SPECI�ICATCONS
PERGt MPACT101d: ud dry d. SUBBASE C. RETEST pF US TEST
o0tained o ssmple�n up oy 5- SppI &CEMEN7 D. MOISTURE �gS OF SAE�IFICATIONS
39 "u 6.01 H�I2 E. MOl PECIF LCAT ONS
* (1) ASTM D1557-00 METHOD A
TEST INSTRUMENT_
REMARKS: PSI did not monitor the material placement_
o Flood plain location.
95V compaction required.
TP-CHNICIAN- Vinnia De- Souza
TM6SE TEST RESULTSlW�LY pM.Y rp 1» 9ECv[C LOCA�IOrq MCR'O •W rwr nod 4�v: rt(i♦:N'r MI'I OTI�R t.Ots�T,ONB OR ELEvwYIONb.
KC"ft WAY NCR OY REAA001iM. EXCEPT IN Wll. Wr,10U1 VMWr8N oeasAss 0H BY %RCFEWI, N INOU6ME& M.
STANDARD COUNT M: 0:
ADJUSTMENT DATA M: D:
Respectfully submitted,
Professional Service Industries, Inc.
PCA --00.2 RIF Prof8S610M1 SWQe WuSVW, IIIC. • 42.240 Green INay, SUR, C . Palm Desert. CA 82211 • Phone i6tN341-5790 • Fax 76OM41-5794
Z ' d 098' ON HOO z Przooa ' V ' 08ak*
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section '109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY` DWELLING
Occupancy Group: R-3 Type of Construction
51-450 CALLE JACUMBA
Owner of Building: CORONEL ENTERPRISES
Building Official
Bldg. Permit No.: 0209-125
Land Use Zone: RM -17
Address:. P.O. BOX 389
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: FEBRUARY 25, 2003
POST IN A CONSPICUOUS PLACE