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r 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 _
Professionals Code, and my License is in full force and effect. .-
License # ' Lic. Class Exp?Date
6..74981 £ r, Ir �i?1�31, Rt
Date t Signature of Contractor '' - ' -'
I.- 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 3TA.TE,VVIIID Policy No. IM29,3,740
(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 Section 13700 of the Labor
Code, I shall forthwith comply wA those provisions.
Date: + Applicant -t+_
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 aa-
nd 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 n at
whose request and for whose benefit work is performed under or p
any permit issued as a result of this applicaton agrees to, & shall, nify
& hold harmless the City of La Quinta, its officers, agents and a es.No
2. Any permit issued as a result of this application becomes nulla v id if
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to can ellation!I
I certify that I have read this application and state that the aboveinfi�
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.
Si nature (Owner/4 ent) N Date
9 �9
BUILDING PERMIT PERMIT#
DATE VALUATION LOTt�{ .Sfi TRACT
J B3,71
JOB SITE
APN
ADDRESS 52.-•W'1i AVA N)VA DW,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
(.10111,09,, Y NIXER.PRWIS
CORONI:L t:' K.TrMUC'f1ON
:t O BO X w E9
76-15,0 CALI TANIPIC0 SiTl'M4230
:E t �I7.I r A, CA 92253
LA QTJJNI A CA, 92M
(360)564--4604 CMM 2261
USE OF PERMIT
SI 01. 1 TFA?e ILY MET IN0
"WD— P-RAdIT 0019-S INOT 04CY..LpDY &i'i..00K.'9IJ'A,LL4 PCOUSPA O
MVE AYAPPROA>C°Hi ASTER" Y!9-2
TRACT CONSTRUCTION 1,445,00 S1'
POKI✓{IP,PtY10 203.00 SR
QA.MGICAR;°C+RT 433.00 S#
5 3171. WOOD F&ICE 200.03 11F
EMyAIXI'7I�.. D C01313.1 OF COA^d�i X'.�'.�`'1�..:��ON
91,926.21)
:�� wrrr FRE r.Js�SP,J�AS. R
CONS'1`'R.LIfw'!"104 PIKE 101.000-418--000 $608,00
PLAN 0111WK FEE 4401-000-439-318 $511.39
Mi,0 IAN ICA:. F1019 101 mt►M4Z I.000 $60.00
lsJ_"4V1'1,UC.AL MR!" 102-OOL-4.20-taut? $119,94
PLU MBIN1O Ful 101 -000-4 29-000 i 1611A
STAONO MOTION i+KE - 3:;&SID 101-000-241-000 $9.29
Ok KIDIIg0 M, . 1031-000.423-000 )20100
Dr—V 5,0!1 ,Pti. IMPACT .W $I,40?.00
I'Iit:C1R S'1�1N 1 101.000.4411^345 $.lflflA
;
11,99 DXP031T � = , • 1. � 101-000-439-318 •$3S 0,G0
® j
"1:r
- Jl.AL CONS'i"IYF,IOItTCt4.l ND I LAW GE -03C
$3,462.31
1 ?t1�11 , L&S'S PRE -PAID PERS
-S.a50.0b
OF LAQUINTA
Wr
RECEIPT
DATE
BY
DATE FINALED
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
/Z �� �
Exhaust Fans
O.K. to Wrap
_ _
, �� ��
F.A.U.
Framing
Compressor
InsulationIG
- (f
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
r
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
Waste Lines
Electric Final
Heater Final
Water Piping
_J U`
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
_
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
Q
S
Final
Utility Notice (Perm)
_
Bu
rauoress—i i- 1 1 —P
Owner C
Mailing
Address l� U �
Contractor
r c ..-A
Address
City
4 4 "
P.O. BOX 1504 -
78-495 CALLE TAMPICO
Z LA QUINTA, CALIFORNIA 92253
sly `1
Zip Tei.
CA).153
Zip
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
arc., «•'+a., . ;,.,..1,,
rp
APPLICATION ONLY
BUILDING: T1�
YPE'CONST. ,JOCC. GRP.
A.P. Number �- ,\ • \, ii, L. -5 Z I -
y L(A Legal Description __7_7 3 55) - Lam,
Project Description S
Tel.
LC `j
City
Lic. # �
City P Zi State
/1, I I Lic. #
LICENSED
affirm that I
Division 3 of
3pter 9 (cora cing with
and my liceneenis Iryfull f,
OWNER -BUILDER DECLARATION
I hereby of ig that 1 m exempt from the Contractor's License Law for the following
reason: (Sec. Q31.5,,Bysrness and Professions Code: Any city or county which requires a
permit to construe , er, 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 (5500).
I-] 1, 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 property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
I
oes 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. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
r7 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 th@ 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, alter 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 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 aOplicant —Date—
Mailing
ateMailing Address
City, State, Zip
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Sq. Ft.(C
Size C
No. ` No. Dw.
Stories Units '
New ❑ Add ❑
-.
Alter ❑ Repair ❑ Demolition ❑
115 NiL9G K U�
'
: (S- Z I 1M -D "1>0cys�'r
)
r
l
Estimated Valuation
PERMIT
AMOUNT
Plan Chk.'Dep.
L) ^=---
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing ;
S.M.I.
Grading
Driveway Enc.
Infrastructure
JjUjINTA
TOTAL
REMARKS
PFRX
e
i
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
y
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: y#
i
Validation:
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
Date 11/15/01
No. 22685
Owner NameCoronel Enterprises
No, 51-795
city La Quinta
Tract # B32
Type of Development
Comments
CERTIFICATE OF COMPLIANCE
Street Avenida Diaz
Lot # 1
Single Family Residence
APN# 773-155-013
Jurisdiction La Quinta
Permit # 0111-056
Log #
Zip 92253 Study Area
Square Footage 1465
ived a cashier's check in the amount of $5916.30 for 2 SFD.
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 mthe amount of
2.05 X 1,465 or $ 3,003.25. the property listed above andthat building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now Ne Jssued-
Fees Paid By CC / Valley Independent Bank - Ish Coronel Tel +Ephone ,=
h
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow Payment Received $5,916.30
Check No. 255488
Signature
40TICE: 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 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 DistrictCs)(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
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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Coronel Construction
SITE ADDRESS 51-795 Avenida D
APN 773 _ 155 _ 013 CASE NO.: 2001-580
LEGAL: LOT i BLOCK -12 UNIT 9 S.C.@V.L.Q.
CHECK AND APPROVED BY: Michele Rambo DATE: I I �1
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
Verify legal and APN.information
Consistent with MDG on file (as
applicable
NI
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
Colors
Materials
Architectural design features
AVE �OQMEN
�.
8y ��
APPROVED pp�E
/
1�(
8
Eovo '
C
Other Requirements:
01
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:
51-795 AVENIDA DIAZ
Use Classification: SFD Bldg. Permit No.:
Occupancy Group: R-3 Type of Construction: VN Land Use Zone:
Owner of Building: . CORONEL CONSTRUCTION
Building Official
Address
City
P.O. BOX 389
0111-056
RC
LA QUINTA, CA 92253
By: RICHARD KIRKLAND
Date: 04-08-02
POST IN A CONSPICUOUS PLACE
---_^r" P. 04
�2 04 :55 AM
ALLATION CERTIFICATE CF -6R
t� �d ress
ern -it um er
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
7B DUCT LEAKAGE REDUCTION
Pressurization Test Results (CFM @ 25 PA)
Fan Flow Test Leakage (CFM)
If Fan Flow is Calculated as 400 cfm/ton x number of'tons; or as 21.7 x Heating Capacity
in Thousands of BrAr, enter calculated value here
If fan flow is measured, enter measured value here
Leakage Fraction - Test Leakage/(Measured or Calculated Fan Flow)
Pass if leakage ftaction 5 0.06 �— ❑
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
CHECK AFTER FINISHING WALL:
13Yes 13No C)Pressure pan test or House pressurization test N111
❑ Yes C3 No C3 Visual Inspection of Duct Connections ❑ ❑
Pass Fail
❑ THERM08TATIC EXPANSION VALVE JXV)
—Yes ❑ No Thermostatic Expansion Valve (or Cornmission approved
equivalent) is installed and Access is provided for inspection ❑
Yes is a pass Pass Fail
CJ DUCT DESIGN
1 • ❑ Yes ❑ No ACCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation matches
plans. n
2• ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, /
verified fan flow matches design from CF -1R.
Measured Fan Flow
❑ ❑
Yes for both 1 and 2 is a Pass Pass Fail
❑ I, the undersigned, verify That the above diagnostic test results and the work I performed associated with the test(s) is in
conformance with the requirements for'compiiance 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
compliance credit.]
Z!,
ests ignature, Date Installing Subcontractor (Co, Name) OR
Performed General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building owner at Occupancy