0005-027 (SFD)co
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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. Dat'
j 634981 B ( /t32/31/2E
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:
( ) .J, 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:
CarrierSTATE FUND Policy No. 154293E-00
(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 Idstiould become
subject to the workerscompensation provisions of Section3700 of the Labor
Co`de,: l shalf forthMth comply.wifA,those'provisions.
Vate: I T -r, IAPPlicant _ \: ,
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
additio;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 performeaI,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 purp oes?
a Signature (Owner/Agent).\J-A--- I Date`-
6- BUILDING PERMIT PERMITk
DATE VALUATION LOT Ck-105-027 TRACT
$92,"7.40 14 LKI 65,U417
JOB SITE
APN
ADDRESSi2-7f1t1AV1IlnanxA.
7722�i�
OWNER
CONTRACTOR/DESIGNER/EN (NEER
j
C:OROMEL CONrtMUCTION
CORONF-L CONMUCIMON
5 1 54.0 MSAOfflOWER DR,
51-540 L-10ENHOVM DR.
LA QUiNTA CA 92253
:C.A QUI TCA CA 92253
('760)504.4604 C Uf 2261
USE OF PERMIT
SWOLE FAINO LY DW_117.1 .11 0
SFD-.PERM,' T DOES NOT INCLUDE BLOCK WALUS OR, POOL
TRACT C014STRUCTIO14 1,492.00 SF
PORCH P.€ TIO 90.00 S@'
CI.AR.AGEIC'.ARPOU (M 9,074AO
5 PT. WOOD PENCE 200.00 LF
COIN' or C ONT911MCrnon
92,987AO
��y.�STMN
C`-ONSTRW1`10N FEE 101.000.418.000 $608,00
PLAN CHECK F'i+'E 101-000%8439419 $302.53
MECHANICAL FIFE 101.000-421- 000 $53,50
X1,W TRICAL IME 101-000-420-000 $130.99
P1A3M13 O FEE - 101-000.419.000 $110.71
STRONG MOTION FEE - RESID 101-000-2541-000 $9.30
ORADINO FEE 101-000.423.1300 S20,00 .
DEII?},,f?PFR IMPAC`P PEI,?. $1,9071;{3
PREC'ME PLAN 101=000-441-345 1100.00
FEE DEPOSIT 101-000-139-319 =$250.00
WB -TOTAL CONB1'IZiJC`txOR� AND PLAN C"H"IC
$3,448.06
LESS PRE4:PAID 1EJ:
-$250.00
?"WAL "IT -MIT 11WIS DUE ow
,l i�6.t35
RECEIPT
DATE B/Y f% °p-
DATE FINALED
INSPECTOR
Y/ i `k-''
�44t'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
–JAReturn
Air
.Steel .
Combustion Air
Roof Deck
OX to Wrap
Framing
�_��= �� S7
Exhaust Fans
F.A.U.
Compressor
Insulation—�S'
Fireplace P.L.
�O `1
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�J
Final
S�
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
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines7
Heater Final
Water Piping
/
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ Qin ��
Pool Cover
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole Y
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final ✓
Utility Notice (Perm) p��
Building
Address
OkZ 5-
� t!`�GitrGv
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Address V ,
Cit Zip Tel.
'.
Contractor,
Addresst'\ �\ K;,� ^ �K
Zip - j Tel.
State Lic. L clTy
& Classif. C��149 � 4 1f Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
111re y affirm that I am licensed under provisions of Chapte(a9 (commencing with Section
70p( of Division 3 of the Business and Profes ons Code, and ig1iyycense/�'s�in Trull 1 rce,�nd
r ti -.
SIGNATURE '�.._>�'! .� DATE
"-`DOWNER-BUILDERDECLARATION
I hereby affirmllhat I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031F$ 9 sfness and Professions Code: Any city or county which requires a
permit to construct, alitel,'"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).
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 or 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.)
1 1 I, 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
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.)
11 1 am exempt under Sec. B. & P.C. for this reason
f
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
(71 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.)
1 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. alter making this Certificate of Exemption you should become
subject to he 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.
1 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
UILDING: TYPPE'CONST. OCC. GRP.
1 1 —)1—r
.P. Number 1
— _CA t,)
egal Description
roject Description Z
w
ly CA, r
Sq. Ft.'t�q1 � No.
Size Stories
New IR Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
�Sz
PERMIT
f f /!1 v AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Y-
Const.
Mech.
Electrical
Plumbing
INSPECTOR
S.M.I.
Date Permit
Grading
Driveway Enc.
Validation:
Infrastructure
TOTAL
REMARKS
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
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 6/20/00 APN # 773-282-010
No. 20574 Jurisdiction La Quinta
Owner NameCoronel Construction Permit # 0005-027
No. 52-700 Street Avenida Diaz
City La Quinta zip 92253
Tract # LK1651N17 Lot # 14
Log #
Study Area
Square Footage 1492
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
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 1,492 or $ 3,058.60 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 CCNalley Independent Bank/Hazani Coronel
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
Signature
Mary Ann L. Borja
Payment Received
Check No
Telephone
n�
kr y
4$3,058.60
216493
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90-dayapproval 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
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
41
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 the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT OORONEL Construction
SITE ADDRESS 52-700 Avenida tai a 7
APN 773 _ 282 _ 010 BIN NO.: CASENO.: 2000-249
LEGAL: LOT
CHECKED BY
14 BLOCK 165 UNIT S.C.@V:L.Q.
Greg Trousdell
DATE:
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
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable
t�
QPZ�
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
e.B —�
Colors.
Tt�
Materials
chitecture
F.X
�N�•
,
--I
+ 1,
(
Other Requirements:
��1Z Z—
rCertificate 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 fol%wing:
BUILDING ADDRESS:*
Use Classification:. SFD
Occupancy Group: R 3
52-700 AVENIDA DIAZ
Bldg. Permit No.: 0005-027
Type of Construction: VN Land Use Zone: RC
Owner of -Building:. CORONEL CONSTRUCTION
��k,
Building Official
Address: 51-540 EISENHOWER DR,
City: LA QUINTA, CA 92253
By: STEVE TRAM
Date: 11-15-00
POST IN A CONSPICUOUS PLACE