0209-124 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch4pter 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 Exp. Date
i��4 98 B 4a ri 11121
�r
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 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.
(N) 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 vL1NJ,) Policy No. J54;a)r. 7-0f
(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 tha(if I ,should become
subject to the workers' compenstation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 'g-.! _.. Applicant -- t N
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on hiS:= 4
application..
1. Each person upon whose behalf this application is made & each person at'
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws -relating to the.building
construction, and hereby uthorize representatives/of this City to enter upon
the above-mentioned property for inspection purpo S.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION [Iy vj{� LOT iry TRACT 7yt i e�
1aiT 7 +YdSu'i V l S .5.. UC 4
'
JOB SITEpq
ADDRESS 51-3 �j30 CA1,167, 11MMEW
APN
770-,O.WrX18
OWNER
CONTRACTOR / DESIGNER / EN (NEER
COR.OMEL MI IERPRIS I
s'°C3RONEL C OM UC'9 "t'ON
P01: )x 399
78A 50 CA'?.IX I AWIC O 9CF�` 1,42 d 0
LA I it fl Cit., 92253
;t:,r�. tr'SfAAfi�al;�. �'A 9225,37
g�� p�q �!
(760)564,4.04 CB14 22tr1
USE OF PERMIT
1605 S.F. S!t`I;'i. PERMIT DOLMS'NOT IINC:9.:C)M 31A)CK:WA1IA POOL m
jaR.i3 IMAM APPROACH
TRACT C-01411V9MUCT1014 2A$.00 SYS
i
ys PORCHP
3 ATIO 40.00 :.yi<
GIARAWCARFORT 463,00 SF
XFrIKAIM) OWE OF CONISIRUCTION
911A:330
M&M,BIN. 9MMUR r
CONSTRUCTION M 101.000-418„000
PIAN Mi t?C1C PMP $521.92
MDEV1U,3IT 101.000-439.318 411.00
MRCHANIC..AJ..IMF, 101-000-421,000 02.511)
191.000.420-000 $113,94
Ai tDMBINOFTE 101-000-4191.000 $FI&00
T l ONO M(r°s O14 F u. - RESiD 101.000.141.000 89.14
'
OR.AL'1P ID FSI? 9 0'9-fif11� �2 �-13(3U X15 �I
D9�WEUWTM Tip PAC i' FES 32,-w,.00
PRrr'.MISE PLAN 101-000-441-345 �180.a0
C
S.
CIF9= °Ai:' tJ1 'J 1 �9 AN11y1PL��yyA3��7',ryc��iy�/t�`..��•:�;
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42:50.00
'e -Pow, IrIFIR5 DV, now
SEP 2 0 2002
MYOFLAQlIINTA
FINANCEDEPT.
RECEIPT
DATE:
BY
DA E`FIN LED
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
Exhaust Fans
O.K. to Wrap .y
F.A.U.
Framing p Gt
Compressor
Insulation 2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection Q �! .G d(r
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice ��3
(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole Y -0
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
°
Main Service
Sub Panels
el, -
Exterior Receptacles'
G.F.I.
Smoke Detectors
Temp. Use of Power -�
Final
le
Utility Notice (Perm) '�f
CERTIFICATE OF COMPLIANCE Ss�NIFIED
Desert Sands Unified School District z4�cS�1R/�oo
47950 Dune Palms Road ¢ BERMUDA DUNES r
Date 9/19/02 La Quinta, CA 92253 rn RANCHO MIRAGE CJ
INDIAN WELLSLM DESERT
ti
No. 23636 (760) 771-8515 PALA QUINTA :V
�INDIO
® J
Owner Coronel Enterprises APN # 770-164-008
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 17 51380 Calle Hueneme 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. 264996
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,434.70 $0.00
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Appllcant Copy - Applicant/Receipt Copy - Accounting
-5-1,380
MMIRECORDING REQUESTED BY:
THE ESCROW SOURCE, INC.
AND WHEN RECORDED MAIL To:
AND MAIL TAX STATEMENT TO:
CORNELL ENTERPRISES, INC.
Order No.
Escrow No. 02.3278 -SA
Parcel No. 770-154-008
SPACE ABOVE THIS LINE FOR RECORDER'S USE
GMNT' DEED
THE UNDERSIGNED GRANTOR(S) DECLARE($) THAT DOCUMENTARY TRANSFER TAX IS $45.10 and CITY $
X computed on full value of property conveyed, or . '
computed on full value less hens or encumbrances remaining at the time of sale.
unincorporated area: X Le Quinta and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
CALVARY BIBLE CHURCH OF BURBANK,
hereby GRANTS to CORNELL ENTERPRISES, INC.,
the following described real property in the County of RIVEERSW E, State of California:
PARCEL NUMBER 770-164-008
LOT 17 IN BLOCK 4 OF DESERT CLUB TRACT RECORDED IN BOOK 20, PAGE, 6 OF MAPS, RECORDS OF
]RIVERSIDE COUNTY.
i
Date July 16, 2002
CALVARY BIBLE CHURCH OF BURBANK
STATE OF CALIFORNIA
} S.S.
COUNTY OF }
On , before me, the undersigned, a Notary Public in and for said County and State,
personally appeared CALVARY BIBLE CHURCH OF BURBANK
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that helshelthey executed the same in his/her/their
authorized capacity(les), and that by his/herltheir signature(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
'� • �.� , � rJ �; $ ;�I 1, � i'J
SH�:ICNA ?; ;+Ails NiNJ l : R .. r,ll%. 'b%' I'1(
r to—e r —cnn14 10•5 ;to( rr,
INSTALLATION CERTIFICATE
8 to Address Permit Number
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
}-DUCT LEAKAGE REDUCTION
CF -6R
Pressurization Test Results (CFM @ 25 PA)�Q
Test Leakage (CFM)
Fan Flow
I [Fan Flow is Calculated as 400 cfm/ton x number of tons, or as 21.7 x Heating Capacity
in Thousands of BwAu, enter calculated value here
If fan flow is measured, enter measured value here
Leakage Fraction - Test Leakage/(Measured. or Calculated Fan Flow) - n
-Pass if leakage fraction <— 0.06 �- ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHIECK AFTER )FINISHING WALL:
❑ Yes ❑ No . ❑ Pressure pan test or House pressurization test /! ,
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections ,/�/� ❑ ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
Yes ❑ No Thermostatic Expansion valve (or Commission approved
equivalent) is installed and Access is provided for inspection ❑
Yes is a pass Pass Fail
❑ DUCT DESIGN
�❑ Yes ❑ No ACCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation matches ' if
plans.
Y•
2. C] Yes ❑ No TXV is installed or Fan flow has been verified. if no TXV,
verified fan flow matches design from CF - IR.
Measured Fan Flow =
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
EY I, the undersigned, verify that the above diagnostic test results and the work 1 performed associated with the test(s) is in
conformance with the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF -6R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for
cumpliam:e credit.
Tests
Performed
COPY TO:
A '
1 / 7 ��•
Signature, Date installing Subcontractor (Co. Name) OR
General Contractor (Co. Name)
Building Department
N1:RS Provider (if applicable)
8::ildinq owner at Occupancy
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 Cons
Owner of Building: CORONEL ENTERPRISES
a't"t
Building Official
51-380 CALLE HUENEME
Bldg. Permit No.: 0209-124
Const VN Land Use Zone: RM, 17-3
Address: P.O. BOX 389
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: FEBRUARY 20, 2003
POST IN A CONSPICUOUS PLACE