9905-088 (SFD)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
f 634981 S /� %� 01/31120(
,Dat%// °l 3
-eSignature of Contracftor•
OWNER -BUILDER DECLA ATION
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).
() yl'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 Policy No.
GOLDEN EAGIS IN.S. 'WCA87860.02
(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 lf�Section•3700 of the Labor
Cod�e�l shall forthwith comply with those provisions.
Date:; �:. r.:--� Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer.to crirginal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labbe 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 prbperty,for inspection purposes.
/ Z / ✓ 1'`J�� r.'.
Signature (Owner/Ageept), t Date
BUILDING PERMIT PERMITk
DATE VALUATION LOT 9"W-098 TRACT
I l • �3 � $89,413—" 16 BLKI 15 017
JOB SITE
ADDRESS
7—_008
52-660 AWNIDADIAZ
773. 8
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CORONEL LVMRPPJSES
CORONEL CONSTRUCTION
51-540 EISENHOWER DR.
5t-54 EISENHOWER DR.
'LA QUINTA CA 922.53
LA QUINTA CA 92253
f76()5t.4-46{}/i CEL€# 2261
-
USE OF PERMIT
Q i`htPYi u say n ikxrf V MANIC r r i x1cl-
Str D - PL:LtitATDOL, S -N(iT INCLUDE BLOCK WALLS OR, FOUL.
TRACT CON`3T'ftt;C ION 1,421,00 SF
PORC°H/PAVIO 36.01 SF
GAx.A,MCARPORT .514,00 SF
5 'F T, WOOD FFNC F, 20.011 LF
11Xf:1) COST OF CONST"i2Wf)ON
89,49.3.50
Pr,, Rklrr FEE: StrNIMARY
Cy'NTTItUCTION FEF 101-000-418-000 $s� .:�►
PL,04 CHECK FEE 101-000-439-318
;`��„f-IAN1C1�.:)+ iz:b""' i li 1 �{1U0-421-•Ut)0 1153.50
k 1;Fi" T RICAL F I E 101.000420 -OW
PLUNIMNO FES 101-000419=000 $1.33.50
5Mt40 MOTION SEE - R9310 101-000-241-000 88.94
U'fUWI NG FFE 10:1-000-423rU00 $20.00
fCdF'ii.k; KfJC•t'{,1" 'FEF 225-000-W-34'2
PRECISE .PLAN 101-000441-345
FEE DEPOSIT 101-00-439-315 -$250.00
SUB-1771'AL CONS"1 ROG TION ,AND .PLAN CHECK
$3,424.44
LESS ML`-PAIDPEES
4250.10*1)
TOTAL, PERMIT .FFF_% DUE NOW
$3.174,44
RECEIPT
DATE
BY i "
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
— 30ST
Exhaust Fans
O.K to Wrap
$ 7
F.A.U.
Framing
52-t
Compressor
Insulation
_� - �� $�7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/
Drywall - Int. Lath
7
Final
Final - o -ty I
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
.(i-
Main Drain
Bond Beam
- u -
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FoQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Building
Address 2 —
h
ce4lt O
Qgw(V �
P.O. BOX 1504
APPLI TION ONLY
78-495 CALLE TAMPICO
%( L+ LA QUINTA, CALIFORNIA 92253
V W 11Cr
c11L y
Mailing j
Address
City ZiCA p Tel.
Co (actor
Addr. ss
,)
C)6),Zip/ Tel.
4 � 2TJ j ��f<� m, Of
State Lic. � City
& Classif. ( P �3 -,I,;` Lic. # z Z (,
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CON�TAiitICTOR'S DECLARATION
I hetab
y affirm that I am licensed unser provisio sh 'of�G'fi8pter 9 (commencing with Section
tX)0) of Division 3 of the• usiness a d Professions Code, and my hcen �Jis in � I force and
effect 4E �L_� —rJ(" %_ 7 �f
e l'
S GNATUR -- DATE
OWNER -BUILDER DECLARATION
I hereb of .ilfrl 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 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 ($500).
f: I, as oner of the property, or my employees with wages as their sole compensation, will
do the wowrk, 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
orimprovement 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 I, 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.)
17 I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3900, 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 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: It, 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
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit i5 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 properly for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'C-O7NST. �^ OCC. GRP. -'7
A.P. Number t �1 C�-"//Ci� (`` �"
Legal Description ' 6 T it- . I J% 1, 1
Project Description gb '
v tut t
Sq. Ft. 111 Z '
Size
New U Add ❑
e_"//c �G
No. No. Dw.
Stories - Units
Alter ❑ Repair ❑ Demolition ❑
I :! '! Uv f C(
,timated
PERMIT AMOUNT
Plan Chk. Dep.5
Plan Chk. Bal. t
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY: �
Minimum Setback Distances: b�
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
a
Issued by: DateY-- Permit
Validated by: p
Validation: APR J ,ri, Iggg
V
WHITE = FINANCE YELLOW = APPLICANT
of `.9° LA* i\_4 ifL(s
PINK BUILDING DIVISION
ti
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 5/11/99 APN # 773-282-008
No. 18720 Jurisdiction La Quinta
Owner NameCoronel Enterprises Permit #
No. 52-660 Street Avenida Diaz
City La Quinta zip 92253
Tract #
Type of Development
Comments
Lot #
Single Family Residence
Log #
Study Area
Square Footage 1,421
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 imthe. arriount of
1.93 X 1,421 or $ 2,742.53 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project niay now.be issued
Fees Paid By CCNIB/Coronel Enterprises Telephone
Name on the check s. ,
t
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,742.53
Check No. 195017
Signature if �_ 1111W��
NOTICE: Pursuant of A3tembly 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 dale 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
collect them on the Dislrict('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