0006-359 (SFD)LICENSED CONTRACTOR DECLARATION
I $iereby affirm under penalty of perjury that I am licensed under provisions of
.`Cr pter 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'
63.4981 is , % 01 /31 /2(
ate"' - t ��` ,Signature of Contractor S✓
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).
( ) 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:
Carver STATE FUAD Policy No. ISA2937-00
(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
woJ••kers' compensation laws of California, and agree that -if I should become
st3bject to the workers' compensation provisions of Section 3700 of the Labor
ode; I shall forthwith comply with those provisions.
Date: L i " -'� Applicant' _ r._• .-
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 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
t above-mentioned property for inspection purposes.
Signature (Owner/Agent):A_41=a Date "7
.7 0
UILDING PERMIT PERMIT#
ATE VALUATION++y� LOT - L TRACT ..qw
y Yy
12
JOB SITE
APN
ADDRESS ss��/������•�ryry•��AA u�� y A
�tl.V.IL•A.YJA A YHJ1 A
174-{K'N.7'•024
OWNER
CONTRACTOR/DESIGNER/EN (NEER -
COROAT"t CC3h1grRuC'x ow
CORONELCONS'TRUC110N•
51.54(1 MSENI-IOWEM llR
51-W WPL-N'.E3C1111 J:, DR
LA Q1: INTA CA 4.225:
LA QilINTA C.A. 92253
(160)564-4604 C.RY_4 2251
USE OF PERMIT
0WGIZ 1?A1v10,Y T9 3(}
SM- LOT 13P4i MIT Db ES NQT INCLUDE BLOCK WALLS C-ZI; POOL
TRACT CONSTRUCTION 1,401,00 8F
PORCWPATIO :35.00 SF
O,ARA.GEIC.ARPORT (3F),10,172,40
5 rr. WOOD F NCE ' � { 700.09 LF
2911 U!" COSr OF CONSIRWrION
PERW FEV, 9bMM RY
CONSTRUCTION FBI 101.000.418-000 $613.50
^. PLAN CHECK FEE 141-000-4:39-318 $500.07
MECHANICAL FEE 101.000.421.000 $53.30
ELECTRICAL, FEE •1,014040-420-•000 $110.02
PLUM131NOITZ 1011.000.419.000 $110.711
STRON C3 moTIO14 IEEE - =10 101-000-241-000 $9.17
ORAUINO FEEE 101.000-423.000 $20.00
DEVELOPER IMPACT FEE $1,907.00
PWX.'13X PIAN 101.0UCL-441-345 $100.00
FBI, DEPOSIT 101-000-430•319 4250.00
9US-TOTAL CON UC1101TAbW PLAN CF1iX,:t1,
1"S PRE PASD WE0
-$250,00
-fUYAL P11.101rCT' FEMS DUN,
8S.3 ,164k1
RECEIPT
DATEBY
/
DATE FINALED
INSPECTOR
1/ i
M
i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
w0Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
. Z - 57
Compressor
Insulation
-9 -441$ 7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
r(— BttJ
Drywall - Int. Lath
:• ,Da 7
Final
Final l S
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
-+dam 27
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
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
Gas Test
Appliances
Final
Final
Utility Notice (Gas) &V 5 .
ELECTRICAL APPROVALS
Temp. Power Pole �o
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:
..;,,�� d. �...-•-„i -.-.- -.., .,., .._;{, �.C-'i �. �- � `:w�.,_,,,y--S'��,.srS .I`..�..?.. .�.r-: .: ,,r.`.,nrY,,,l•r�.» <1''=�.'-: ,;.}`,L '�.. ter,. h i .. ., .. � _
o
l22p
P.O. BOX 1504
Building APPL C ONO S
J. �C 78-495 CALLE TAMPICO
Address J' �J `� `�� \\ LA OUINTA, CALIFORNIA 92253
• Owner '
Mailing _
Address 1�s
city Zip Tel.
CA
Contractor
. (_ 0 (_ L.) h.S�
Address
City\\
;�C^ �Ji_•-N
Zip A
CA
Tel.
50-1 _%��/`
V
State Ljc.
- " & Classif. �� t `
City
Lic. # �� t
Arch., Engr.,
Designer
Address
Tel.
CityZip
U
State
Lic. #
.// LICENSED CONTRACTOR'S DECLARATION
Thereby affirm that I am_licensedd urSder provisions of C pter 9 (commencing with Sec
7000) of Division 3 of,tlre Biusines9 and Professions Code_ d.mv u..... is in f..0 r,..,.e
OWNER -BUILDER DECLARATION
I hereby affirm�Jiat I am exempt from the Contractors License Law for the following
reason; (Sec. X103,1.5, 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 (5500).
1-11 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 Coda: 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.)
II 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 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
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 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 (he 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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip • _
BUILDING: TYPE•CON'ST. I OCC. GRP.
A.P. Number --7 �I1 '— n h,�— ,i-.\� — - !!,,
Legal Description \_QNt, �� r ��� ��� 10y, I
V
Project Description
Sq. Ft. (� / {
Size O t
No. 1
0St"ories !
.No. Dw.
.e' Units
New L] Add ❑
Alter ❑„*Repair
❑ Demolition ❑
U
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
'1. ”
r V
Plan Chk. Bal.
Const.
W Ii
Mech.
f
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
r
J f'. -
TOTAL
•:
REMARKS
r
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Settack from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK= BUILDING EIVISION
r 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 -.7113/00 M APN #: 774-063-024
No. 20718 Jurisdiction La Qtxirita
rt
Owner Name'Coronel Contruction . F r Permit # -
r` w' No. 53-235 Street Avenida Villa
Log # ` -
City La-Quinta' . .. Zip -92253 Study.Area a
N L {. 4. 1 -
Tract #'" i Lot # ,12" . SquareFootage ', 146► a
Type of Development Single Family Residence No:'of Units 1;.
x`
At the present time, 'the Deset Sands Unified, School District does not. collect .fees on 'garages/carports, covered '
patios/walkways, residential additions urider.500 square feet, detached accessory structures or rep:acement mobilehomes. It
' has been determined -the above --named owner is exempt from paying school fees at this time due to the. following reason:
k EXEMPTION NOT APPLICABLE = .
This certifies that school facility fees imposed pursuant to Government Code 53080 :4nthe amount of
2.05 X x1,461 or $. 2,995.05 the property listed, above and thct building t, '
permits and/or Certificates of Occupancy for this square footage in this proposed project'may now be issued
at
- ,
Fees Paid By cc Valle Independent / Coronel `
- Y p Telephoie 564-4604 . -.
v Name on the check �.
By, 'Dr. Doris Wilson
Superintendent .
.'Fee collected /exempted by Sheryl Simmons Payment Received 52,995.05
+ 'A'
:Check•No.* 222877. :r
Signature ,
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 may g rotest 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(s) or to another public entity authorized -to - �•t
ollect them on the District('s)(s') behalf, whichever is, earlier.
Collector: Attach a`copy of county oe city plan check application form to district copy for all waivers.
Embossed_ Original- Building Dept:%Applicant Copy - Applicant/Receipt,'.' Copy Accounting
a
•
c.
X54` .
...
e
Commonwealth Land Title Company
72855 Fred Waring Dr., Suite A5, Palm Desert, CA 92260
Ruyer's Settlement Statement _
Escrow No.: 9875KC
Buyer:
Property:
Escrow Officer:
Date
CORONEL ENTERPRISES, INC:, A CALIFORNIA CORPORATION
APN 774-063-024-3, LA QUINTA, CALIFORNIA 92253
Kelly Collier
052400
DEBIT CREDIT
6;;000 00 ..
' CORONEL' ENTERPRI SES m:16,45 0: 00..
COR ON EL ENTERPRLSES %; g.:. «. o ;� �2-33-68�:;r.:.�::
..... Z. 24/0..07/1/0
.3.08NTYTE2w
37 days .@.62366 per diem.'
LE,DER-.CHARGES.
ESCROW; FEES, TITLE CHARGES
ettT'ement.Charge (Including Slr's)
Q'ocument Preparation
Owner's Title Premium
POOR
Escrow Waived,Fees
RECORDING FEES, TRANSFER TAXES,
Record Grant Deed
Documentary Transfer Tax
324.00
40.00
273.00
25.00
-25.00
6.00
17.60
$16;683.68
$16,683.68
F
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 recuire.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 �uxuiv�L C:VNS'1'KUl'1'1ULV
SITE ADDRESS 53-235 Avenida Villa ~'
22 2000-250
APN 7 7 4n ti n? d BIN NO.: J CASE NO.:
LEGAL: LOT 12 BLOCK 2 0 1 UNIT 2 0 S.C.@V.L.Q.
CHECKED BY: Greg- Trousdell DATE:
Inform the assigned Building plan checker upon your assignment to this cas . The CDD -Executive
Secretary'maintains a log book to track applications d 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'
MDG filing required (5 filings since 9/3/98)
.Consistency with street/surrounding area:
. ' Colors
Materials
Architecture
�: P:
�..
'
✓
�C, S�,��:
.
Other Require ents:
`1/w /Ll�•-f"� %/fes- C6rN £� h� Qhs ` �
r.
to
of.'Occupan.cy.'.
�i
Cityof La uin .
Building. and Safety'Department:'
This. Certificate issued pursuant to the requirements of Section 109 of the .Uniform Building Code, '
certifying that, at the 'tune of issuance; this structure .was in compliance with the various ordinances .
of the City regulating building construction or. use.- For the fallowing.-.
B'UILDIN.G.ADDRESS: 53-235 AVENIDA -VILLA
Use Classification:. 'S. D. Bldg. Permit No.:. 0006-359
Occ.upancyrGroup:. R 3 Type of Construction:.: VN Land Use Zo.ne: RC
Owner of Building: CORONEL CONSTRUCTION Address:. 51-540 EISENHOWER DRIVE
-City` LA QUINTA, CA. 92253
By: STEVE TRAXEL
��.►� Date: 12-22-00
Building Official
POST IN A CONSPICUOUS PLACE