9902-118 (SFD)Fes—
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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
B /�1
r (TO �.R a�
Date`-'' 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
1
-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 Policy No.
GOLDEN SAME M& 414WC48230-02
(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 Sectio
3700 of the Labor
CodI s forthwith comply-with-thoseosprovisions. '�` t�
Date Applicar�x. a �-.� � g r7� )'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up ib $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, 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 authorize representatives of this City to enter upon
the above-mentioned property for. inspection purposes.
Signature (Owner/Age? - .� Date
PERMIT #
BUILDING PERMIT
"02-118
DATE VALUATION J",413 4% LOT 18 TRACT 8165, U17
JOB SITE ADDRESS tis�+t Q AWNIDA
APN 773.182-006
OWNER
CONTRACTOR / DESIGNER / ENGINEER
kS1GQUlhi, C;ORO- ! 1,
CORMEL CONSTIRIUi°'fION
5I-540 EISENHOWER DR.
51-540 E1SENRUWEP, DR.
LA QUI-KI'A CA 92253
1.A. QUilTrA CA 92253
(760)564-4604 t,rAL9 2261
USE OF PERMIT
51NOLE 4t1MILYDi1VEi„LI"iv.G
SHD - PERMIT DOES NOT IfvCi. i/1).1~ tB1,00K. 3W'AI.I.S OR POOL.
T ACT.'ONS"Ii, UC710311 1.4.11A SF
VORMPA'110 36.00 Sr
GARAGE/E::AfW1':W $14.00 -SS
6 'FT. WCKJ , RNIC1 x00.00 L
ESTIMATED PfiNOF WNpSTq UCTIyN
89,4so
113I:'IMMIT ITE AL3{ ARIARY
CONIS` RUCTI.ON R-16 101-000-418-000 $594.50
P11AINCi P3K FFM } 41 -p00 -r1
S51.50
,IMtCLNICALPEP,
CCJE1RICAL FIS 101-000-20-000 J12.32
PLUMiU'C O.FEE 101-400-419-000 5133.50
STR ONO MCJ'►ION.. _3 P.319) I0t-MO-241-004 S8,94
OWUMrnC r• cc IN -000-423-000 {►.�r,
:tNFRASTRLI1 .!'URE I ?fi 225-,100044.7-342
PRF,'001 1, PLAN €01-000-441-34.5 $.100.0
T1)1^h0311F 1t11-000-439.,318 •5250."9
t ._ f+vi; 71 r (,'(lRl i'ft i l�"T t��? �1 N 7 �I:1� 3�4 {moi 3 r r
$3,44y.44
1 ,S .P E-1 JUD RES
-$250.00
TOTAL .#'ERN1.1<'t FEE -S DUE NOW
$3,249.44
RECgIPTT �,
DATE/
BY /' P
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck —
Exhaust Fans
O.K. to Wrap + _(�p — Q Ce
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
BLOCKWVAI I APPROVALS
POOLS - SPAS
steel
Set s /Z
Electric Bond
outings
Main Drain
Beam 9
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
e es0
Heater Final
ping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 31Z 0 tf
Encapsulation
Gas Piping
Gas Test y
Appliances
Final
Final
Utility Notice (Gas) Ij
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 4 146
Utility Notice (Perm) Y-1 y T ki, I
COMMENTS:
I I
T4ht 4 4 "
P.O. BOX 1504 APPLICATION ONLY
Building//�� ]� 10-495 CALLS TAMPICO
Address 52 - (p 20 A ✓z PIAZ LA QUINTA, CALIFORNIA 92253
Owner
Mailing 1� v
Address
Lb UOIINTI III
gal Description/— �� F3 s
- �� �(Ll � 'A,,j r
� G
Project Dcription- r
peon e ( r-1 r,
Sq. Ft. j� �� No. � ,,,,
No. Dw. �l
Size ! Stories --III Units �1, l
New/ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
1
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: Dt Permit
19��Validated by: JAN 2
Validation: OF UPA
11,
.4
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
CERTIFICATE OF COMPLIANCE
Date 2/26/99 APN # 773-282-006
No. 18395 Jurisdiction La Quinta
Owner NameEsequiel Coronel Permit #
No. 52-620 Street Avenida Diaz Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1421
Type of Development Single Family Residence No. 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:
EXEMPTION NOT APPLICABLE u
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount, of ti
1.93 X 1,421 or $ 2,742.53 the property listed above and that building
' r, " t
Permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By cash Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Adriana Gauto Payment Received $2,742.53
Check No. n/a '
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
:ollecl 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
I.:
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, 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
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT: CORONEL CONSTRUCTION
PROJECT
ADDRESS: 52-620 Avenida Diaz
APN: 773-282-006
LEGAL: LOT' 18 ,.BLOCK 165 UNIT 17 , S.C. @ V.L.Q.
C K' D BY: STAN SAka
BIN NO: 4B CASE N0. 99-40 CHECK DATE: a-'3
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 I Y I N
COMMENT/CORRECTION
Case logged and number assigned 2-1-3
Verify legal and APN information
Consistent with MDG on file las applicable) �►
MDG filing required (5 + filings since 9/3/98)
-C-onsistency-with-street/surr..ound ing-.area :
Colors `l
Materials �I
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.
06/26/1994 17:28 6195644202
BuildOn
NOLOConad
Ift • lasOW
CORONEL CONSTRUCTION
PAGE 03
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: VI31011ICA PROJECT: 52=620 AVENIDA k�
COR01M CONSTRUCTION LA QUINTA, CA
P.O. BOX 389
LA QVINTA, CA 92253
DATE:
North
March 02, 1999
corner
of
OUR REPORT NO.; 073 - 90063 -2
pad
2
TEST DATA:
(1) Light brown,
medium to
coarse
sand with
silty sand OPT.
MOIST.
-
10.5%
TEST
of
TEST
pad
4South
_.._...
SOIL ID
west
LAO DRY *
WATER
WETDRV
rERGENT
COMMENTS'
;Spec. 90% Min
N0.
DEPTH
ELEVATION
NUMBER
DENSITY
CONTENT
DENSITY I OENSITv i
ComrACTION
1
811
F.G. *
1
118.0
8.7
I 1x7. 7 i 108.3 _
91.8
; L
- A
2
8"
F.G.*
1
118.0
9.0-
! 117.0 107.3
90.9
1
A
3
e"
F.G.+
1
118.0
8.8
I x16.91 107.9
91,0
L
A
A
all
F.G.*
1
118.0
8.5
116.3 107.2
90.8
1
A
........... _....,..
TEST LOCATION: Houle pad
1
North
went
corner
of
house
pad
2
North
east
corner
of
house
pad
3
South
east
corner
of
house
pad
4South
_.._...
. _—
west
corner
of
house
..._—•
pad
-- ---- - - -•---._.. I
NOTES: TESTS W10
ASTM D2=-91 8 ASTM D3017-88(93) -COMMENTS: 1. FILL MATERIAL A. TEST RESULTS COMPLY WITH SPECIFICATIONS
aC2. BACKFILL 8. PERCENT COMPACTION DOES NOT COMPLY
3. BASE CgOgURSE WITH SPECIFICATIFRFTEST OF pOSUNS
P E +Ory TES
a, SOIBHL CEMENT MQ1 T URE EEOW SE?OCf SC ECIFICATIONS
* (1) ASTM D-1557, Procedure A
TIONS
TEST INSTRUMENT: Ttroxler, 3411-B, 13099 STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: D:
**F.G... Finish grade**
Respectfully submitted,
TECI•}aVICIAN- Jinn Nunez Professional Service Industries, Inc,
THESE TEST MWAtS ABLY QK* TI4 *P LCOATIONB MOM AND MAY NOT R&PREMiT ANY OTHER LOCATXM OR eLEVATIONS.
REOORTS MAY Ndf M M /ULL M111'HO{!f VWffr M PCRMIS810N BY MWItestoNAL BERM" MUSTRIES, INC.
vsmwat w ProhmskmM Ssi v Ind"es, Inc. • 42.940 Green Way, Suite C -Palm Desert, CA 92211 -Phone 619/341-5790 • Fax 619/341.5794