0209-102 (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 Exxp� Date ..
Date 4, �t `t Signature of ContractorX '
OWNER -BUILDER DECLARATION
I hereby affirm,. under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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,_,Businessprofessionals Code).
( ) I, as• o'w`ner of theoproperty, am exclusively contracting with licensed
contractors tot construettie project (Seca 7044, Business & Professionals
Code).
() I am exempt. under Secjon B&P.C. for this reason
Date '/Sgr(atureof Owner
WORKER'*COMPENSATION DECLARATION
I .heFeby affirm under ,pb4d ty of perjury one of the following declarations:
O I have�antl will maiAta`in a certificateof consent to self -insure for workers'
compensation;, to provided'for by'Section 3700 .of the Labor Code, for the
performance of=the work dXwhich this permit is issued.
( „) L 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'& poli%kno. are:
Carrier STATE FUND � Policy No. 154%93`1-01 '
(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,;arid agree that if I should become
subject to the workers' compensation provisions ofj'Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.;/ .
Date: ;*• Applicant )i -_f A"
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
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 nulland 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 Wth all City, and State laws relating to the building
coi;kructidn,J,gnd he.re6y Yauthorize representativese of this City to enter upon
the above-mentioned property for Inspection purposes.
Signature (Owner/Agent)-h-110 Date ; ?
BUILDING PERMIT PERMIT#
=2s•4 -1O
DATE VALUATION LOT TRACT
D oa -�;
*8 7141K WAX 06 UJOB
SITE!
ADDRESS �%a`�i i�°ati�bla� r
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
, ix'(Ah�33t'•�VV�7.-389 t��1aa�'AA
'T9.15t7D����.'x`M�'A�7� �.�;te�J'1CO Sir.tr"nEgW2• �1
t�yyH�uS5
1A Ly�l�.ialtl TA CA. 92 53
L.A. <! dLE�11iC'�. � CA 922 3
t�
(760)564=4604 m -A. 2.2rji
USE OF PERMIT
MN au ?A4Vm•y DWMDI TO yr
1461 S.V SFU PERMIT 0623 'NOT 1NC'1,bC3G.noCK ww, .'poo o
DRi'VIt"WAY' A.ffiftOACH
}
C4AC`F CO?i"3Z'PUCT1014 44U00 SF
POI1.CWPATIO, 36.fl.f'i S'tt'
4' t`ARA01MARIPORT
r
PERNIT.1901' SUMMARY
com rauC'I`ol Fn 101.000.418yi0 5585,30
PLAN w.HK 'YEE
'£ T DEPO3!' 1 Cil rtS�JiJa�}' 3 z $ $2rit,
MWHAXICAI, FU 101 -0004v �Goq 959.00
91 -000410-000 $108.44
MIUMBINC;< PF f
STROM MOTiiON FRE - RUID ' 101-00044 -1-000
Syys3,fltlR,.cf�i1Yy:��1�1�rlCc�9 Mr, 101 PPOr{•2"s'-000
94 'SIF. PLAN 101 1-345
t ij4t : -
SUP,^�IYYI'AT.. � 3Ai�"1t'1� C1Ct ��f.)2� _Wks 1�rLAX 0'k3kaCK
*3{M. 13
D
OCT 2 2001
.000FLAQUINTA L
FINANCEDEPT.
RECEIPT :•
DATE � O�
BY �.. i
DAIVIN� LED �
INSPECTO�
INSPECTION RECORD
OPERATION j
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
_
Q
Exhaust Fans
O.K. to Wrap
O
F.A.U.
Framing
_
_.03 ��/
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 15,-Zc) d3 ,��_
BLOCKWALL APPROVALS
POOLS - SPAS
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 Lines
L
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1 Z_
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
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
Final _
Utility Notice (Perm) ' G
COMMENTS:
�L�C Ll1 ( P73 1.2-- Cf- o `Z
Ife
15
..BOX 1504 APPLICATION ONLY
6il1 ) 78-495 CAL'LE TAMP.ICO
".Address �) _ \�/ _ �\\\ LA QUINTA, CALIFORNIA
`92253 '
pry
Owner
BUILDING: TYPE,'CONST.' OCC. GRP.
Mailing �i
Address ; ,.. . `� A.P. Number 1�� ti ''a
Cit Zi Tel. -
' Y� ;P� : ~I ` LegalDescriptionf� �1r , '-•. t �»: C is
`.
-Contractor.. �- �, .i •v
_ :' � Project Description
Address
• City Zip _ Tel..
State Lica City
& Classif. it t,` Lia # 4
Arch., Engr., 4.
Designer
Address Tel.
City Zip State
Lic: #
n LICENSED CONTRACTOR'S DECLARATIOI
I)hereby affirm that I am licensed"underjprovisions of Chapter 9 (commencing with Section
7000):of-Division-3 o'ff the Business i6d�Professions Code, a,{nd my -license is inlfuyll I ce.'anCr
SIGNATURE - 1 -/' DATE
r' OWNEWBUILDER DECLARATION
.I hereby 'affirm that;f em exempt from the Contractor's License Law for the following
reason: (Sec. 7031,.5,,88uusiness and Professions Code:. Any city ; or county, ,Pubch'� requires a
permit to construct, after.'improve,�demo6sh,-o, repair,any stmcture; prior to'its issuance also
requires the. applicant for such permit. to, its
a'. signed sfatemenbthat he is licensed pursuant to .
the provisions ;of the' Contractor's -License 'Law, ;Chapter: 9'Icommencing,wltA Sectkn„7000) of
Division 3•of the Business.and Professions Code; dor that. he. is' exempt therefrom,• and the basis 7
�lorthe 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 dollais (5500).' '
CJ I, as owner of the property, or,my employees with wagei as their sole compensation, will .
do the work, and the structure is not intended or offered for sale. (Sec. 704, Buisness and '
Professions Code: The Contractor's. License Law does not apply to an owner of property who
k builds or'improves thereon ,and who does such wOrk'himself or through his own employees,
P
rovided 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 confractor(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 -
rI 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
C.7 Copy is filed with the city. 0 Certified copy is hereby furnished.
,. CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE .
(This section need not be completed it the permit is for one hundred dollars ($700) valuation
or less.)
1' I certify that in the performance of thg work -for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
_x Date Owner
r NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject, to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
` r
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) _
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
I agree Id comply with all city and, county ordinances and state laws relating to building
construction, and hereby authorize representatives 'of this city to enter the above-
§- mentioned property for inspection purposes.
Signature of applicant - Date
Mailing Address
A ' City, State, Zip
tr
WHITE = FINANCE YELLOW
f .
�'=h.. ::':1.*ur.+. ,. �.���: .,. •r.$:i�.l �:-.... :'�:,:.t.xi',r ah ... a7.. 1f�r': /.,7 �.;
REMARKS
Sq. Ft.iii
Size 1 O .
No. 1 No. Dw.
Stories ` Units
'
New O Add ❑
Alter G Repair ❑ Demolition ❑
y
ZONE:
BY:
Minimum Setback Distances:
•
Front Setbac c from Center Line
.i
Rear Setback from Rear Prop. Lina
Side Street Setback from Center Line
i
Estimated Valuation
;)
PERMIT`„`
AMOUNTr
-t
PIan,Chk. Dep.
J>
Issued by:
Plan Chk. Bal.
Validated by:
Const.
Mech.
r
5 i
Electrical
;;•, t3
Plumbing
y
Grading
7! fA 1
Driveway Enc.
PINK = BUILDING DIVISION
Infrastructure
.,.vz ii.r ;�,;•..., .-6c iP,r:..'�:
_. 3,.ai�:�x=�..a .—+a,_;`�-4 M.,.;.. ... l.c_ a.:i- '�'.ie. _. t.w �.. ._�.r".". _ 'I
� {r
.. _.. ,r�"',Yf
TOTAL
REMARKS
ZONE:
BY:
Minimum Setback Distances:
•
Front Setbac c from Center Line
.i
Rear Setback from Rear Prop. Lina
Side Street Setback from Center Line
i
Side Setback -from Property Line
FINAL DATE
INSPECTOR
J>
Issued by:
Da_e Permit
Validated by:
Validation:
y
APPLICANT'
PINK = BUILDING DIVISION
.,.vz ii.r ;�,;•..., .-6c iP,r:..'�:
_. 3,.ai�:�x=�..a .—+a,_;`�-4 M.,.;.. ... l.c_ a.:i- '�'.ie. _. t.w �.. ._�.r".". _ 'I
� {r
.. _.. ,r�"',Yf
Date
. 10/28/02
No.
23785
Owner
Coronel Enterprises
Address
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
N�1FLEbsC
us. CO)
Q BERMUDA DUNES l -A
rn RANCHO MIRAGE
INDIAN WELLS
di PALM DESERTLA
4 INDIO Ti�~�7
0
774-063-021
La Quinta
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 9 53175 Avenida Villa' 1421 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 paltios/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 1,421 S.F. or $3,040.94 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed proect may now be issued.
Fees Paid By CCNIB - Ish Coronel Check No. 27f877
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,040.94 0.00
Payment Recd Over/Under
c -
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 projBct 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/Applicant Copy -Applicant/Receipt Copy -Accounting
t/17/2002 14:25 7607777011 LA QUINTA PAGE 02
Oui•il- Zuut"II:IVAM No•4317 P,
1111111RECORDING REQUESTED BY:
THE ESCROW SOURCE, INC.
AND MEN RECORDED MAIL TO:
AND MAIL TAX STATRMENT T0:
CORNELL ENnRI'RISES, LVC.
Order No. R-2124834
Escrow No. 02 -3215 -SA ��)
Parcel No, 774063-021 774063-022 LV I Ob
`
17 Y /L- L A SPACE ABOVE THIS LINE, FOR RECORDER'S USE
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAXIS 673.7D aad CITY S
X computed On full value of property conveyed, or -
oomputed on full value lose liens or encumbrances remaining at the time of sale.
unincorporated area: X LA QLANTA and
FOR A VALUABLE CONSIDERATION, receipt of which Ig hereby acknowledged,
JOSEPH E, RAWLAVSON, A Married Man
hereby GRANTS to CORNELL ENTERPRISES, INC.
the following described real property in the County of RIVERSIDE, Stat® of California:
PARCEL NUMBER 774-063-021, 774063-022
LOT 9 INBLOCK 206, OF SANTA CARATELITA AT VALE LA QUINTA, UNIT 20 AS PER MAP MCORDED IN BOOK
i.
19 PAGE 38 OF MAPS, RECORM. RIVERSIDE COUNTY.
Date rut 16 20112
JOSEPH E. RAWLINSON
STATE OF CALIFORNIA )
COUNTY OF }
On before. me, the undsrslgned, a Notary Public in and for said County and State,
personally appeared JOSEPH E. RAWLINSON
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 he/she/they executed the same In his/her/their
authorized Cep2Clty(le3), and "that by his/her/their slgnature(a) on the Instrument the person(s), yr the entity upon behalf of,
which the person(s) acted, executed the Instrument.
WITNESS my hand and official 9921,
Signature
0117'061 ri�unun „inn
MRK-1'L—'L10106 kdb_:623 HM - P. 04
INSTALLATION CERTIFICATE (Page 2 of 8 CF -6R
-7 Lcj er t .. um er ,
@ Address
FENE$TR6T1QN/GLAZ&9:
Total
Quantity
of Like exterior Shading
U FProduct
odu t(S S lOduc(S M of Product Square Device or Commcrttc/Location/
acto: r pl, net
A
(GROUP LIKE PROD) .. - , ^ Ifr ✓l"t . L Z✓
4.
6, —
8. —
9.
• J
14, --
12.
13. —.
14. —
l s. —
' Manufacturcd'fenestration products use the values from the product label. Field fabricated fes s ration products usc,tht
default values from Section 116 of the Encrgy Mciency Standards.
' Installed U -Factor must be less than or equal to values from CF -IR, Installed SHGC must be less than or equal to values
from CF -1R, or a shading device (exterior or overhang) is installed as spaeificd on the CF -IR Altematively, installed
weighted average U -Factors for the total fenestration area are less than or equal to values fron CF- I R.
I, the undersigned, verify that the fenestration/glazing listed above my signature: 1) is the actual fenestration product
installed; 2) is equivalent to or has a lower U -Factor and lower SHGC than that specified in tae certificate of compliance
(Form CF. 1 R) submitted for-tiompliance with the'Energy Efficiency Standards for ratidcntial Wildings; and 3) the product
meets or exceeds the appropriate requirements for manufactured devices (fl•om Part 8), where applicable,
Item #s /i2nn"ature, Data Installing Subcontractor (Co. Name) OR
(if applicable) Oeneral Contractor (Ca. Name) OR Owncr
OR Window Distributor
Item 98 Signature, Data Installing Subcontractor (Co. Name) OR
(if applii:able) General Contractor (C). Namc) OR Owner'
OR Window Distributor
Item qs Signature, Date Installing Subcontraett:r (Co, Name) OR
(if applicable)Ganeral Contractor (Co, Name) OR Owner
OR Window Distributer .,
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
January 4, 2001
Nov .25 2002xa, 1 37PM FR TO 95544202 No•8310"0zp 3
REPORT QP rIF-LD :COMPACTION TES 7 S
OVZ ;ZEPURr NO.: 0� 3 0 9 A- v CLIENT: c 0
oaTE \\ 1 2 rRe,ter: — r�.r^r► e.L�f�+11Jo, V1L1-�•
ul)CIAAA CAUCE INFORMATION ANO OA+IY STANLARO CALIORATIQN Numbos '/LAIR TI50, PERCENT,•l- Ga06E aojusY fmT X VARIATION FRO
_r•uiR,a TION COONTS FAOAt SHEETS UST VSE
'�VOd TY��bTAOXIftV MreEu natSTustE: `00 '•OIIYVRft _ _ I,IOISTut Ir �tO;LTuNt,
11091 UO.• DENSm; I OENStTv: I O:r.SrtY; I
)v,OR Ir• OIINIATION,.
;011 ID = VISUAL CLASSIPICATION OF SOIL ` Nna X. DRY,OE�:SITY, ?Z;F I OP7lN1U,M P+tO15TURE.
O\\�N%. G R
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r.��ea I tnr� In�i. %l,\t-n\-,ir, ,V1
nnQUlfteMENTS. 90 `� Q i;EQUIRFMEIvTS,
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I
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TEC.'WICIAN:
EST �E;A I]ING DUO Tt ENT/ SOLI.----
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ME$ NOT COMPLY wry. SPECTFICAt 1014S
ot:t.gw srocl�t;nnarts
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Celrtifi ateofpan CCUc
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0
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a _ Cit of.La: in
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' � ``� - AFM of �ti9 ,
Buldin and Safet De artmentr:
" z� 1��
This Certificate issued,pursuant to the requirements of ,Section 109 of the Uniform Budding Code;
u a
.:certifying that; at the'time of issuance, this structure was in compliance ivitht�ihe, various ordinances
of the City regulating bui/ding construction, -or use: :For the fo%%wing: p
- ,
1 _ -
f.,BUILDING ADDRESS: 53-,175 AVENIDA_VILLA
Use Classification. SINGLE FAMILY DWELLING ,Bldg. Permit No.. 0209-102 S'
Occupancy Group: R-3 Type,of1C6nstruction:VNy Land Use Zone,' ° RC
ti' - - , yr - a ' ♦1 .� • . ... t • y+. }
Owner of Building:, CORONEL ENTERPRISES Address:- P.O. BOX "189 = :-
R
r:-
t
City:, LA,QUINTA,�CA92253 `•
By:'- KIRK KIRKLAND+f
Date: ..MARCH 20, 2003
Building Official ...;,
POST IN A CONSPICUOUS PLACE