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9703-011 (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 ts34461 B /� � f� ,/DateDa,/Date !�l � �/ Signature of Contracto��► 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 sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the,property, am exclusively contracting with licensed contractors t0 construct, tne. project (See. )'U44, BUSHII488 & PrOfessiorlais 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. KI 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 y.r-, Policy No. k ,•� liV �. iadl'� 'd.1 r Fs.(�1 (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 te-the-., workers' compensation laws of Califon 'a, and agree that if I should become subject to the workers' compensation orovisiorfs pf Section 3700 of the Labor /Codey hall f •5WitV comply with®those provisions. J Date: - (/APPlicant �t`A/ i r l�..t.�✓L��---" 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 null and void it';`1 work is not commenced within 180 days from date of issuance of such t 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-abQ��e 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 t enter upon the above-mentioned property for Inspection purposes. t i nature (Owner/A e t Date PERMIT# CONTROL# BUILDING PERMIT 9703-011 9"76 DATE 4114/4��% VALUATION c .ra�ri.0(1 LOT S TRACT ,� -, JOB SITE 53465 LiWNIDA, VI1. L't ADDRESS APN OWNER CONTRACTOR/DESIGNER/ENGINEER 1"'4#r: UI r..1, (,.-x)R 0N,V1, C,t l 0.111til, CONS"I'W'(.`i'CON LA,00IN'T"A- CA, 0225713 1A LH11NTA CA 9_'2S3 f'ft'1`►.��i-1t:f)�! C'13I:,f� '':'�I USE OF PERMIT ,hL)-.t't (INiIi OL4—.8Ni-)t Tw!.l ik13L.C1t k WALLS / TI. AI„ "1' o.%)I lSTIOA,_ YtiiN SF (' *(3HIATIO Sk 0,kRA(_ifiX'ARP010' ?liM1.t3l) SF 6I -Y W0(01''EN'1 R. (4) 1 t.;(.,;F; e� t.��� �.�z�ci�:�i�a�9 "16100 8911897.0'4 `yy� ��yy yY +yp,�� a ` xxpRGG pp ��l••:))..%+i�..I.i�ii.t��%ED C,O, ti111 SIR 11,1CI N F1 P 1(11 d1(}(1 4iNnt3fhl � a.'iG (>.ta't ix -,IN $ �11,tttj A!'.(j1itiN1 A1. N i.+°. ' . ii)[�£?f)t!-/I2t-(s(1U $till tN) UILIR. JIRI Ai, FI -W 101 000-4`12 -000 S122.93 m,I6.° to:acs y:{;3. $t?f31% C3RAUt.NC.1EFAE 101--00i-423-(iW i Ct.trU 41yTFRASTRUt'.'rUkf0-`I'sl: '235-000-443-342 g1,944,93 PREr'3RK?P1 AW �{}1 1ii1f1 441-t1C �!S.fN) _v a�r��[, �``�)'NSX�T�,I�."1'►t�?3 f�l�l1� 1�1'�tl?�i f ,'h1F�C'11 ��,,�;1� (int LESS Vii1:-j?AID FEES -$,250,00 .._ 7°,rn. PR 14199�s�; � °�: ;r�A 0UF; NOW A S3,1� 69 � LA QUIN'TA ()ITY OF RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION -RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade 2 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing 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 BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final zlz 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 4 P.O. BOx•1504' APPLICATION ONLY Bujldin 78-105 CALLE ESTADO - ---9 r--2 LA QUINTA CALIFORNIA 92253 Owner r- :5e Mailing Address City 1�4 U, V? Contractor C C AZ 0/1 e Address city � State Lic. & Classif. Arch., Engr., Designer Address 4'. BUILDING: TYPE CONST. OCC: GRP.. - > 3) Zip Tel. PC/ 2 z s 3 .3c . Zip Tel e1/_L/6D41 City 2 2 � � • Lic. # Tel. CityI Zip I State I Lic. # I hereby affirm that I am licensed under prdvisions of Chapter 9 (commencing with 000)fof Div(sion 3 of the Business and Professions ode, and my licen's�is i (f�UII h ffecn f dit r f _� �J� OWNER -BUILDER DECLARATION I hereby affirm 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 applicantfor a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). IJ 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, 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 didnot build or improve for the purpose of sale.) FI 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.) - I-1 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 ❑ 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: 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. 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. I certify that I have read this application and state that the above information is correct. 1agree 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-. merltioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION A.P. Number 774 - oq 3 - o ( 3 Legal Description 31k. : 3 Project Description �• �� S. C . V 41,6 L U W tT Z.0 Sq. Ft. No. No. Dw. Size I . �.I Stories Units New ❑ Add Alter C Repair ❑ Demolition.❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. UO Plan Chk. Bal. Const: Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL ate. 60 REMARKS ZONE: BY: Minimum Setback Distances: Front SetbacM f?om Center Line Rear Setback from Rear Prop. Line' Side Street Setback from Center Line Side Setback From Property Line FINAL DATE INSPECTOR r Issued by: Dat✓ Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FE IST FL. SO. FT. $ 2ND FL. SO. FT. POR. SO. FT. @ GAR. SO. FT. @ CAR P. I SO. FT. WALL SO. FT, SO. FT. (a ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property tax valuation COLL. AREA FLOOR DRAIN ROUGH PLUMB. MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER FORMS VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) ROCK STORAGE APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL HEATING (FINAL) FURNACE UNIT WALL FLOOR SUSPENDED REINF. STEEL LAUNDRYTRAY TEMP. POLE AIR HANDLING UNIT CFM KITCHEN SINK WATER HEATER ABSORPTION SYSTEM. B.T.U. TEMP USE PER SVC WATER CLOSET BOND BEAM COMPRESSOR HP POLE,TEMIPERM LAVATORY _$ HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER FRAMING BOILER B.T.U. SO. FT. ® c BATH TUB SO, FT. p c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11A c SEWAGE DISPOSAL SO.FT.GAR @i 3/ac HOUSE SEWER FIREPLACE GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST, FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Wr Desert Sands Unified School District �' 82-879 Highway 111 Nctice: Document Cannot Be Duplicated Indio, CA 92201619-775-3500 ` CERTIFICATE OF COMPLIANCE Date 4/9/97 APN # 774-093-013 No: 15417 Jurisdiction La Quinta Owner Name Esequiel Coronel Fermit # No. 53-265 Street Avenida Villa Log # City La Quinta zip 92253 Study Area 111 Tract # Lot # Square Footage 1410 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 barages/carports, covered, patios/walkways, residential additions under 500 square feet, detached accessory structures or rTplacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: t' EXEMPTION NOT APPLICABLE. This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.84 ..X 1,410 or $ 2,594.40 the property listed above and teat building permits and/or. Certificates of Occupancy for this square footage in this proposed project may'now be issued Fees Paid By cc/Valley Independent Bank/Coronel Enterprises, Telephone 5644604 Name on the check ' ti 1+ - By Dr. Carol McGrew Administrator in Charge Fee collected /exempted by Pauline Pearson t` Payment Received $2,594.40 Check No. 134826 Signature IOTICE: Pursuant of Assembly 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 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 Dislrict(ss or to another public entity authorized to ollect them on the District('s)(s') behalf, whichever is earlier. " Collector: Attach a copy of county or city plan check application form to district copy for al-. waivers. Embossed Original- Building Dept./Applicant Copy `Applicant/Receipt Copy - Accounting ,