0209-104 (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
634983. ��• �r^ �'A,�:?1/fit
,.Date k� . 4 Signature of Contractor
y, ti..
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
4f•.v v .
sale (Sec. 7044,.Business.& Professionals Code). i
( ) I, a ��wne 8f the property, am exclusively contracting with licensed
contractorsao. construct the -project (Seca 7044, Business & Professlonals
Code).
() I am exempt under Sections B&P.C. for this reason
Date Signature of Owner
WORKER'SXOMPENSATION DECLARATION
I hereby affir under penalty of perjury one of the following declarations:
O I hayed will maintain afeertificate of consent to self_insure for workers'
compensates, as provided. fo by Section 3700 of the Labor Code, for the
performanc oftFierbvork for'wh ch 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 O•i:+ME RAID Policy No. 1'320 ,•01
(This sectiori,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 thgtl if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply wlth�those provisions. '
Date: - Applicant
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 andSafety
for a permit subject to the conditions and restrictions set forth on Misr
Application. z
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.
•1 certify that I have read this application and state that the above information is
Correct. 1, 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/Agent) Date' vi. I'
- Ic•t:fl"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE qp�t
ADDRESS�rca
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WykZi:�W:C;l.. °,�� TERP148 _ r ,•
�'
coif
�&- o BOX 381.4
� 7S-150 CALUTAMEsICOt20��210
��
LACZ��.W1.i1�T �`.�t ���rs
LAI 010'I;j! TA
USE OF PERMIT
Ai1d6;1.!Lraa%Y..t.�.rd
l'.. X(Yf Li4CM 11I2);r:� T-0C.K.' WALI, PCIOL. OR
t1•�4„2�1�,7S.iYrggSf�' q�',FC:a•C�':[��t�a71'�pOi ��OW'
it
Y
` 19�PdCTY CC1 4VTRU TION M,11.00 Ss1F
•i�CYI;.Cfiilip.A'I'lr:� :fti.OLi,:;A'
''
-.!if2 AY.7:+! .A.'.S.Sr•S!, is09f 01Y C-OATSMUC -1014
C4 Y,6:45, 5o
PLAT CHECK VIM $2142
FEED POSIT 4230100
hAVICIR”' IC,l§LFMI, $3P.01)
R 1, 0 F.! "1ItIC1A L Fpill 1311-WO.420.000 $108,45
-PL;VA3d3WO FEE
STRONO Mt?T1 ax • RXI- it) I0.1,d?U0,.� IfiIM00 5176
h�I'A13iO tit��IT '" u. 1G?3 •1Q�a-�9f1i9t�33.ITLTLt
I:�$s�'d''K CSI' It•INII'At::`1 Cs f% ;au 't2,�t0 :tr0
PRECISI'f r4AW l opt Q100 h�3A _us $l"Jem,
• rr :� ti's
' S�.i�.`ISS�.'�r�_ ���h�.•�. ',�J�LI'�.Iii'Cil;�?.➢��JESS�
�50Ci,.
.
PR�y:k"lPk?,et'as 5EM S
D e
4200'
.. m'xwr f —TIMI 19:Dela NOW
1. r sa187
W4at-
OCT 2 P 2001
t•
CITYOFLAQUINTA?
FINANCEDEM.
RECEIPT
DATE
BY-
DATE FINALED
INSPECTOR
INSPECTION RECORD
- OPERATION
F 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
G,
Exhaust Fans
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
_
� � L
G� G _
=��
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
i
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
w A I,c i' r�-
l —10-03 !2Af—
_
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
Final
Utility Notice (Perm) -���
r''"':vr"-+•"-ens'--"•"V1inyM'y":,ys'�K�3"('�"s - TMvUa,Y/rq�q"IS'Y� _
i?
0 i'
C
BOX 1504 APPLICATION ONLY
Building, 7LO
Address LA OUINTA,.0ALIFORNIA
. 92.253
Owner
BUILDING: TYPE•CONST- OCC. GRP.
Mailing
AddressD L� _ ?ti<� `' A.P. Number
City •zip TeL -Leg ^
a 1 �. �e t al Description.\,i
-�\. \i .• . 'l�� 4_ Cil . y '� v
�1'y;tj
Contractor,--' 4 Project Description
Address !
City ( Zip Tel..
State Lic. City
& Classif. if Lic. # -N '" r ` No. No. Dw.
a> ..:. `. Sq. Ft- \ l Stories
Size l Units
Arch., Eri
Designer New O Add ❑ Alter O Repair ❑ Demolition ❑
Address TeL
City ZipState
_ Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am license i ..at provisions of Chapter 9 (coir tmci
enng with Section
0) ofrD
' 7g0ivision 3 of the m tan P fessions Code, and my licerise ism full force andorg
9 �•
SGNATUR ..r
OWNER BUILDER DECLARATION
I hereby al rin thi am,exempt froi%the,Contiactor's License Law for the following
t reason: (Sec. 17031.5,9usiness� and Professions .Code: Any city or county'whicD' requires a,"
S, permit to cons ruct, al er, improve, demolish, `or repair any structure, prior to Its Issuance also
requires the appllc�t 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). .
t.: 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. (Seca 7044, Buisness and
Professions Coder 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 theDurdan'
of proving that he did not build or improve for the purpose of sale.)
I'1 I, as owner of the property, am exclusivelycontracting with licensed contractors to con-
' strucl 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 contractors) licensed pursuant to the Contractor's License Law.) _
0 1 am exempt under Sec. B. & P.C. for this reason
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
f7 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 (5100) 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: If, after making this Certificate of Exemptionyou should become
Lsubject 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
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 it 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 apiplicant Date
Mailing Address '
City, State, Zip
AMOUNT
r •
i7OF QuINyA
1RAIRM UEFT.-I
REMARKS
t
Estimated Valuation '
PERMIT
ZONE:
Plan Chk. Dep.
Minimum Setback
„Plam'Chk. Bal.
Const.'
,•f Mech.
',Electrical
-Plumbing
FINAL DATE
INSPECTOR
Issued by:
Grading ,y . (j Ul
Driveway Enc.
Ill It
Infrastructure
lu ' f tt
1.1
TOTAL
AMOUNT
r •
i7OF QuINyA
1RAIRM UEFT.-I
REMARKS
t
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback 6rom Rear Prop. Line
Side Street Setback from Center Line
Side Setback 'rom Property Line
FINAL DATE
INSPECTOR
Issued by:
Dat- Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Date
10/28/02
No.
23786
Owner
Coronel Enterprises
Address
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
Lot #
Unit 1 10
Unit 2 -
Unit 3
Unit 4
Unit 5
Comments
No. Street
53189 Avenida Villa
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
S.F.
1421
Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
�N��YI:F[js,C�
Q 13ERMUDA DUNES r
rn RANCHO MIRAGE
INDIAN WELLS
�. PALM DESERT
LA QUINTA
�INDIO
APN # 774-063-022
Jurisdiction La Quinta
Permit #
Study Area
No. of Units 1
Lot # No. Street
S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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. 270878 _
Name on the check Telephone 760/564-4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Gdillen $3,040.94 0:00
Payment -Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this prgect is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
I
1%
07/17/2002 14:25 7607777011
[UUZ ll IUW,
1111111RECORDINQ MQUESTEb 9Y:
THE (ESCROW SOURCE, INC,
AND WHEN RECORDE13 MAIL TO:
AND MAIL TAX aTATEMENT To.
CORNELL ENTWRI9E5, INC.
'Order No. R-212483-1
Escrow No. 02 -3215 -SA
Parcel N9, 774-063-021 774-063=022
LA QUINTA
PAGE 03
No -43N .P..3
53-189 r11/16 va GR WOMW! ABOVE TMIS UNE FOR RECORDE USE
GRANT DEED
THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAXIS 573,71) aad C]TY-S
X computad on full value of.property conveyed, or
computed on full value less Ilans or encumbrances remaining at the time of sale.
unincorporated area: X LA QUINTA and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JOSEPH E. RAWLINSON,. A Married Man
hereby GRANTS to CORNELL FNTERPRiSES, INC.
the following described real property in the County of RIVERSIDE, State of Caflfomia:
PARC$L MJMBER 774-06�-02I, 774-063-022
LOT 10 IN BLOCK 206, OF SANTA CAR?ViELTTA AT VAL& LA QUINTA, UNIT 20 AS PTR ANAP RECORDED IN
BOOK 19 PACE 38 OR MAPS, RECORDER, RIVERSID$ COUNTY,
Date July 16, 2001
JOSEP S S. RAWLINSON
STATE OF CALIFORNIA }
}ss.
COUNTY OF )
On before me, the undarmigned, a Notsry Public in and for said County and State,
personally appeared JOSEPH E. R WLINSON
personally known tome (or proved to me on the basis of a®tlsfac:tory evidence) to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/e.he/they executed the same in his/her/their
authoriZad capaclty(les), and that by his/her/their signature
which the person(s) acted, executed the instrument s) on the instrument the person(s), or the entity upon behalf of
WITNFzSS my hand and official seal,
Signature
t _ .
07/17/2002 .14:25 7607777011
JU I l l . !UUL I I. 11.10
�1
IIIUIIRECORDING RLOQUESTED BY:
M. ESCROW SOURCE, INC,
AMD WHEN RECORDEp MAIL TO:
AND MAIL TAX STATEMENT To:
CORNELL ,ENTMFRms, INC.
Order No, R-212483-1 .
Escrow No. 02 -3215 -SA
Parcel N9. 774-063-021, 774-063-022
LA QUINTA PAGE 03
No,4377 P-3
53" 1 Ll V/LLA °rA�e A90VE THIS LINE FOR FiECORD� USE
GRANT DEED
THE UNDERSIGNED GRANTOR($) DECLARE(5) THAT DOCUMENTARY TRANSFER TAX IS 573.77 and CITY S
): computed on full value of property conveyed, or
computed on full value lase Ilans or encumbrances remaining at the time of sale.
_unincorporated area: X LA QUINTA end
Fpl2 A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged,
JOSEPH E. RAV41NSON, A Married Man
her6by GRANTS to CORNELL ENTERPRISES, INC.
the following described real property in the County of RIVERSIDE, State of California:
PARCZL NUMBER 774-063,021, 774-063-022
LOT 10 1N $LOCK 206, OF SANTA CA,jlZMELI'TA AT VALE LA QUINTA, UNIT 20 AS PER MAP RECORDED IN
BOOK 19 PAGX 38 OF MAPS, RECO"ER, RIVERSIDE COUNTY,
Date July, 16, 2002
JOSEPU B. RAWLINSON
STATE OF CALIFORNIA
) S.S.
COUNTY OF )
On before me, the undersigned, a Notary Public in and for said Coy my and State,
personally appeared .JOSEPH E. RAWLINSON
personally known to me (or proved to me on the basis of @sNsfa(-,tory evidence) to be the persons) 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 capacity(les), and that by his/her/their signature(s) on the instrument the parson(s), or this entity upon behalf of
which the pprson(s) acted, executed the instrument.
WITNESS my hand and official seal,
Signature
1'1MR 1L—LC!CJJ C/O:YlJ H1•I - • Ps 08
1
INSTALLATION CERTIFICATE (Page 2 of 8) CF -6R
Site dress
Permit - um. er
FENESTRAT;IQ GLAZINC>•i `
Total
Quantity �..
Product Ptoduct of Like Exterior Shading
U•Faetorl (S. SHCCI (S q of Product Squire Device or Commcros/Lominn/
_
Manufacturer/Brand U&me CF I R value F I R valueh PERU (0 riann/) Feet Overhkna Sa cal Features
(GROUP LIKE PRODUCTS) ✓M L�`�t/
d , 3F -7
I
4. –
5.
6.
7. —
8.
. 9.
12.
13, —
14.
15 —
Manufactured fenestration products use the values from the product label. Field fabricated fenestration products use the
default values from Section 116 of the Energy Efficiency 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 -IRF or a shading device (exterior or overhang) is installed as specified on the CF -t R. Alternatively, installed
weighted average U -Factors for the total fenestration area are less than or equal to values frorr, CF- I R.
1, 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 the certificate of compliance
(Form CF -IR) submitted for -compliance with the Energy fcieney Standards for retidential bjildings; and 3) the product
meets or exceeds the appropriate requirements for manufactured devices (from Part 6), where applicable,
'
k i nature Date Installing Subcontractcr (Co. Name) OR
Item s g 8
(if applicable) General Contractor (Ca, Name) OR Owner
OR Window Distributer
Item #s Signature, Date Installing Subcontractcr (Co. Name) OR
(if applicable) General Contractor, (Co. Name) OR Owner
OR Window Distributer
Item Ns Signature, Date Installing 'Subcontractor (Co. Name) OR
(if applicable) '' , General Contractor (Cc.. Name) OR Owner
OR Window Distributor
COPY T0; ' Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
January 4, 2001
Nov 25 2��2��:1
36PM FR
TO 95644202 NO.8310.01P '2
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VISUAL CLASSIFICATION OF SOIL I
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OOES nor COMaLY wTTN SftC,F;CATIQN:
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Huildin w and Safety-Depailmelft G MOF
JET
This ,Cer'tificate issued pursuant to therequirements of Section X09, of the= Uniform Bui/ding Code, :.
certifying that, at' ther tune of issuance, this structure was,in compliance with, the. various ordinances
of the City regulating bui/ding`constr_ uction,or use.: For `the fol%wing: r 7
BUILDING ADDRESS. r..
� 53-189-AVENIDA V1L'LA-
r Use'Classification:SINGLE FAMILY DWELLING ' Bldg.*Permit No.: 0209:104
r Occupancy Group: R-3 , Type,of`Construction: ;VN, '.Land Use Zone` :RC L
- ,,JY ' _ ;' � � , ,3-•, r -' / ; I fir" • �
Owner of Building:;�"CORONEL ENTERPRISES ` Address:''-P.O. B'OX'189 r t'
City'; .LA QUINTA, CA 92253
y By: KIRK KIR
. KLAND,l .
, `k Date: MARCH 20, 2003 .
r Building Official
f•
r {" POST IN A CONSPICUOUS PLACE - '