0009-067 (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 fdeceand effect.
License # Lic. Class ...,,Exp. Date
I ne;-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:
( ) , 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, Business & Professionals Code).
1, 'as owner of the property, am exclusively lusively contracting with licensed
contractors to construct the project (Sec. 7044,., Business &-Professionals
Code). ' .. - -, . . . . . I
O 'I am.exempt,under Section ,B&P.Q. for this reason
Date Signatur6 of 'Owner
WORKER'S COMPENSATION DECLARATION
'
I hereby affirm under penalty of perjury.'f the following declarations -
O 0
o��
I have and will maintain a certificate of consent to self -insure for. workers'
compensation, as provided for by Section 3,700 of the Laboe'Cbde, for the
performance of the work for which this permit is issued.
Q.d have and will maintain workers' Compensation insurance, as r6quired by
Secti on 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.
3
' MD TATR,-
(This section need not -ladcompleted if the permit valuation is for $100.00*or less).
J 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 f I should become
subject io the workers' compensation prcivis . ions of Segfion 1 3700 of the Labor
boe
Code, I sh6ll forthwith comply with tho" pro6sio6s.
DA: (c,.. .Octl Applicant ''\?'
/Warning: Failure to secure Workers' Compensation coverage Is 6ni -a w'f ul and
shall subject an employer to criminal penalties and civil fines uplo" $'10"o,000', in
addition to the cost of compensation, damages as provided for in S-ection 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT App . lication is hereby made to the Direqt6r.o`f.BUilding'ah`d 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, indemnity
& hold harmless the City of. La Quints, 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 fdr 180 days will subject permit to cancellation.
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 relatingto the building.
!construction; and hereby authorize representatives of. -this City to enter. 'upon
the above -Mentioned property for, Inspection purposes.
VSigInat - ure •(Owner/Ageht)\� "i . ,Date—J,
..
BUILDING PERMIT PERMIT#
'Wrofi'; TRACT DATE VALUATION LOT T",4,'
, (h
It
JOB SITE 1
ADDRESS
APN INV
53 --VM AVFUqfDA'VXL1,A
774-064-009
OWNER
CONTRACTOR DESIGNER ENGINEER
LUCAS C01tOKE1,
copoNrL cowsritud now
LA
78.150 CALLE'rM01100 OUTYRDWO
I.& qumm CIA 92253
u.,C)IIA4TA CA 92253
(76()*64-4.604 CAIA. 2261
USE OF PERMIT
1ST'K0L*(F VAVOI.T. Y T-MaULDWY
VD.
Tlt&(l CONSTRUCTION 116n.00 of
PORCHV,010
Q&.R&0V4"ARP0RT (111 T 9,114.00
5 PT. WOOD FfIrNcz 200.09 L-TI�
Rgrqurtv awr ov contramcglon
PERMIT, FEE I& UAT"My
tX), M 8 TA U C TJ ION 7 -ft, V, 301-000-418-000 7433,50
PLAN CHECK FFIX" 101-000-4119-318 $519,17
M-ECHA141CAL IT9K 101-000.,421-000 SGQ,"
101 -000-420-wo
St itd'w OTION VAIZE o MID 101-000-241-000
MUCII, , PLAN
-U M
-CM
.8 B-T(YrAL CONISKRU MON AND PLAN 7
$3,517.64
1=5 FRES
424(100
'rum, rMumn F.g.'n Dtrjr. Now
$12,2,67b4
L
RECEIPT
DATEBY
DATE FINALED
INSPECTOR
1
INSPECTION RECORD
OPERATION
Final
POOLS - SPAS
Steel
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & FootingsS7
Main Drain.
Bond Beam
Slab Grade1_�._!y
Approval to Cover
Steel .
Underground Electric
Roof Deck
/ L,2�t, dw
S7
O.K. to Wrap`
Framing
7
zl8"�e o
S T
Insulation
Waste Lines
Water Piping
_
[D _37 �7
Fireplace P.L.
Plumbing Top Out
Equipment Enclosure
Fireplace T.O.
O.K. for Finish Plaster
Sewer Lateral
Party Wail Insulation
Pool Cover
Sewer Connection
Party Wali Firewall
Gas Piping
,
Exterior Lath
Drywall - Int. Lath
/
sz•
OPERATION DATE I INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air '
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Lines
Final —ZQ%O / S7
BLOCKWALL.APpROVALS
Final
POOLS - SPAS
Steel
Set Backs
(
Electric Bond
FootingsS?
%rZ!
Main Drain.
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
_
[D _37 �7
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
,
Final
COMMENTS:
I ELECTRICAL APPROVALS I
Temp. Power Pole -
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utilitv Notice
T4tyl 4 4 Q"
P.O. BOX 1504
Building- ._`7 i,G� �( Vt L -L A LA QUINTACCALIFORNIA 92253
Address LS-�
Owner / \
l U L CAS
Mailing
Address
CityZip ITel.
Contractor
_ 3
Address I�
City \ Zip C Tel.
State Lic. Ir , , City
& Classif. 7 1. Lic. N
Arch., Engr.,
Designer
Address _ Tel.
City
01-kq LIC
�,D.if",I
YCENSED CONTRACTOR'S DECLARATION
that I a licensed under Drovisions of Chapter 9 (commencing with Section
3 of th�Business and Professions Code, and my license is in full force and
I hereby affirm that I am exempt%frbm 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).
l- 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 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
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 contrac(ors) licensed pursuant to the Contractor's License Law.)
t'! I 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
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 it the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, alter 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
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 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
00t D"-
APPLICATION
"
APPLICATION ONLY
BUILDING: TYPE'CCOONST../ OCC. GRP. q
A.P. Number /7 — 06 �1 ("/
Legal Description / /J1
Project Description Is • L '
';Cidv, _-\ c;.- N C—
Siz Ft.� L ) Sto
Size Stories l
New ® Add ❑ Alter ❑_
Estimated Valdtpn`' (_011111009
C\'..,f1_�
No. Dw. i
Units
fir ❑ Demolition ❑
PERMIW
' AMOUNT
Plan Chk. Dep.
5 `
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
C ' ► ".�
Infrastructure
`'-r ., 2 "11)
aa y�
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Seback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING 01VISION
f a'
Desert Sands -Unified School District
47-950 tDune Palms Road
r Notice:La:Quinta, CA 92253. "
Document* Cannot' Be Duplicated 760-771;8515
CERTIFICATE'OF COMPLIANCE.
Date ,-10%26/00 APN # '774-064-009
No. ' 21144 � Jurisdiction La Quika ^
' Owner NameLucas Coronet • " .,Permit #0009-067
No. 53-200 Street'`Ayenida Villa t t Log #' f. ,
City La'Quinta.. ,zip :92253 StU6 Area .'
,Tract # BLK205 U2� . -Lot #, 15 . Square Footage 1689, `
r Type of Development Single Family Residence ` ` No. of Units ,, I
Comments {, -P '
At'the ,present time, the Desert Sands Unified School District does;not',collect fees ,on garages/carports, covered
patios/walkways, residential additions under 500 squarefeet, detached, accessory structures orreplacement:mobilehomes. It
has been'determined the above-named owner is exempt from paying -school fees afthis time due tc'the following reason:
EXEMPTION NOT APPLICABLE �` u
This certifies that school facility fees imposed pursuant to` ' tovernmeq't.Code 53080 r 'in the, amount of
t 2.05 X 1,689 or $ 3,462.45' the property listed above and that building.:
r_ permits and/or Certificates of Occupancy for this square footage in this proposed projeci-may n6w, be issued
• •• L - yt. ../.w �P fop " •. � ,
Fees Paid By CC / Valle Inde endent Bank /Ismael Coronet
Y y p Telephone 760=564-4604- "
-
a • Name on the check
By', Dr.,Doris Wilson / A
q - Superintendent
Fee collected /exempted by Annette Barlow s- a •Payment Received • $3,462:45 `
J ^ �.. Check No., 2288.67107
Signature; /
t
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS.1996) this will serve to notify you that the 90 -day approval period in which you mayprotest the fees or other payment identified
bove 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(e) or to another public entity authorized to
ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach. a copy of iouno or.city plan,check application form,to district copy for all waivers.
Embossed: Original- Building Dept./Applicant iCopy - Applicant(Receipt. Copy Y Accounting '
• v�srasvuttC►Viii?uaY ct�'�Yi�' Y 9 N 1� SBI: � -
` RE CO R1jN5'_9M7J_UESTED BY
_ ►' CHICAGO `'TITLE_ COMPANY r
AND WHEN RECORDED MAIL TO
(LUCAS M. CORONEL f
51-324 CALLE TAMAZULA
LA.QUINTA, CA '92253 .
a Y
-DOCAS 2000-309091
08/09/2000 08:00A Fee:6.00,
Page 1 of I Doc T Tax Paid
Recorded in 0-7ficial Records .
County of.Riverside
Gary L'. Orso
Assessor, County Clerk b Recorder '
111111 IN 1111111111 IN 111111111111111*1111111111111
I` ' - :. .- _ a 1. ' 111 I I V I iMF MI,
Escrow No. 207014550 -,F32
Order No. 20.7014550
A R L COPY- LONG REFUND NCHG
EXAM
GRANTDEED Assessors Parcel No:
THE UNDERSIGNED GRANTOR(S) DECLARE(s) 774 064�0
j0
Q9 Lo
DOCUMENTARY TRANSFER TAXIS $18.15
❑ unincorporated area 0 City of LA QUINTA
computed on the full value of the interest or property conveyed; oris
❑ computed on the full value less the value of liens or encumbrances remaining at time of sale, and 53 _ Z op
FOR A VALUABLE CONSIDERATION
MOUNT ST. MARY'S COLLEGE receipt of which is hereby acknowledged,
'
or
hereby GRANT(S) to 'CZ
LUCAS M. CORONEL, A SINGLE MAN.
the following described real property in the City of LA QUINTA
Countyof RIVERSIDE t '
, State of California:
LOT 15 IN -BLOCK 205 OF SANTA CARMELITA AT VALE LA'QUINTA UNIT 20 X.S_PER-MAP RECORDED
IN BOOK'19, PAGE 38 OF MAPS, RECORDS -OF RIVERSIDE COUNTY.
t
Dated July 25, 2000 MOUNT ST. MARY'S COLLEGE
STATE OF
COUNTY OF
SS.
On 1
}
before me, BY' v` '
e.li, ;=
a Notary Public in and for said County and State, personally appeared
Q BY:
Doud—
personally k wn to me (or provedto me on the basis of satisfactory J
evidence) to be the person(s) whose name(s) is/are subscribed to the a"
within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), and that by his/her/their R J. IAUBACHM .
signature(s) on the instrument the person(s), or the entity upon behalf of 0,124b01
which the persons) acted, executed the instrument.
i Nof�r P1ibRC - CalffvNp
WITNESS my hand and official seal./418e1es irmrdy
My Cor -M E>PkW Dee 11, 2I0M
Signature of Notary Date My Com ISSIon Expires '
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLFORNOTARY SEAL OR STAMP
SAME AS ABOVE OWING LINE: IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
Name Street Address
GD1--05/30/97bk City, State Zip
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 CORONEL CONSTRUCTION
SITE ADDRESS 53-200. Avenida Villa
F
APN 774 -' 064 - 009 BIN NO.: I CASE NO.: 2000-311
LEGAL: LOT 15 BLOCK 205 UNIT 20 S.C.@V.L.Q. - -
CHECKED BY: GrPq Tro isd _11 DATE: '
• ` Y
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
w
Case logged and number assigned
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 CORONEL CONSTRUCTION
SITE ADDRESS 53-200. Avenida Villa
F
APN 774 -' 064 - 009 BIN NO.: I CASE NO.: 2000-311
LEGAL: LOT 15 BLOCK 205 UNIT 20 S.C.@V.L.Q. - -
CHECKED BY: GrPq Tro isd _11 DATE: '
• ` Y
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
- �OQ�F L�
Verify legal and APN information
Consistent with MDG on file (as.applicable
PAIV
MDG filing required (5 filings since 9/3/91 Q
,
Consistency with street/surroun 'ng area:
Colors
G 0U U Jil Materials
Architecture
\�\
NI
'
-'
Other Requirements:
- I .
g'nl D