0012-238 (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
/ate . Signature of Contractor
`.`
OWN ER-BUILDER•DECLARATION
I hereby affirm under penalty of perjury that l,arn 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 &. Prof essionals Code)..,
( ) I, as owner of the property,` am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).'' ,
O
lam exempt under Section ; B&P.C. for thisreason
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 Labbr.'Code, for the
performance of the work for which this permit is issued.
(L 44 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 Policy No.
ST ATL+WND l s 3"d f06►
(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 Calif6i iia; and agree that if I should become
subject .to the workers' compensation provisions of Section 3700' of'the Labor
Code,I shall forthwith comply with those`.-provisionsF lir
Ffbate: f .< Applicant
Warning: Failure to secure Workers' Compensation coverage:is unlawful and
shall subject an employer.to criminal penalties andcivil 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.
ti. .
1. Each person upon "whose behalf this application Is made & each person at
Whose request and.forwhose 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 Quinti, 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
the above-mentioned property for inspection purposes. •
V.Signature(Owner/Agent) Date'
PERMIT #
' BUILDING PERMIT w.
a
DATE VALUATION LOT' 5�w�l •TRACT
JOB SITE•
APN
ADDRESS l
1.e �? ►JTd+"s �:---�- :.
77 m.,2'?4.6X)1.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LA QUUA. CA, 92.213
LA.. pUMA CA 92752
(761)564•-44AM, CsKS 2261
USE OF PERMIT
811901Z FAMU"Y'Dw MEMO,
SMI - P1. RMiT 1)0k-, W.Ai_t g 11002., & SPA. OP,
l�}I� EWAY.k°ak1t'114:r,i:FI.
OA
a
Tk4fiWT CONS RUCT1014 1,461.90 ar,
POR,CIaH,fi ATi0 36.003 .SY
RAORMAR1a00 (S). 10,172,40
5 ;�`l'.1Rl CJf3i21�1.�ldC,;E 300.00 U?
'P`iRVr PIT SUM&ARY
CONSTRUCTION FEE 101400041:&M
PIAN Cft( X STE9 . If17.-lJf9ej-,i.3 8
M.&:t;;,F1lt41110v'AL FLEE -Wo
Y?pi�` .. ' 1114Yt}t��-i3�G-G3tD?J iltt+.a3
1�I.,i:IPJl13�1NG FRE` . `'1 fit -066419-0210
i`i'k6110 MOTION MEX - RZiSI JI 101.000-2.1.000. $9.17
'13:fY..AJii11'1C1 F9. ' i, 1 Ot9c9�4 3-Qc9cP :tHI OHJ
Mio.J.aD:taY,.R IMPACT Fes..
:1'RF41YE FLAX 101-000-441-443 5140:U
E°'W.1? TaZVftSIT 101--OW-439-318
d.�r-`TUliGC'rdEr~')'Y:11A2]'PAID
yI�S�A.,'Ck4Olt (}10
I
y/1q
POD, i .
SAN ®3 200 e z OW,
10;r X4.01
_TY
RECEIPT
DATE, f��
B�Yf �ry
DATE FINALED
INSPECTOR
�Z-120
fir INSPECTION RECORD
r5 •
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings 5�
Underground Ducts
Ducts
Slab Grade
{ '`
Return Air
Steel
_
Combustion Air
Roof Deck_
Exhaust Fans
O.K. to Wrap
�C.pt
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L.
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
c'
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Footings
g
(-'L _
Electric Bond
Main Drain
Bond Beam
ept
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines_
Water Piping
7'l�
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�__/p—oo S7
Encapsulation
Gas Piping
Gas Test_��
Appliances
Final
COMMENTS:
,
,
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)
Building
Address
P.O. BOX 1504 APPLICATIN ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 j
cltyd —� \� v • \ 1]`II 2Z� � I I4:1-,(.0 ti c.
Contractor_
Address
City 1 r lZip JTeL
State Lic. G r City
& Classif. ?,y 1 t Lic. # a_
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION\
that I am licensed unddergrovisions of Chapter 9 (commencing with Section
;8 of tfje'Busig�ss�andlProfessions Code, anp my license is in fuJ,l.(orceand
OWNER -BUILDER DECLARATION,
I hereby affil that ?m exempt from the Contractor's License Law for the following
reason: (Sec. 703,U,Busin.s. 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 perm!(
subjects the applicant to'a civil penalty of not more than five hundred dollars ($500).
I] 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.)
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 contractorts) licensed pursuant to the Contractor's License Law.)
1-1 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
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, 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.
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
BUILDING: TYPE'C-^O�NSST. t ` DCC. GRP.
-'-^
A.P. Number I ! l - � 1 -c% —7 [[
Legal Description 71:) �Ll\�4- k(
Project Description
CA
Sq. Ft.
Size ` �,
c-1. V\
No. No. Dw. `
Stories , Units
New ❑' Add ❑
Alter ❑ Repair'❑ Demolition ❑
r
,
I
P
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
5,10. o.0
Plan Chk. Bal.
Const.
,
Mech.
Electrical
Plumbing.
S.M.I.
Grading
Driveway Enc.
i
Infrastructure
_fie 1 4
TOTAL
REMARKS
Q
ZONE: BY:
Minimum Setback Distances:
Front Setback fron Center Line
Rear Setback frorr Rear Prop. Line
Side Street Setbadk from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
.t
�', Desert Sands Unified School District
{ 47-950 Dane Palms Road
Notice: La Qtiinta, CA 92253
r
Document Cannot Be Duplicated • 760-771-8515 ,
CERTIFICATE OF COMPLIANCE ,
Date 1/2/01 APN # 773=274'001
No. 21430'
Jurisdiction La Quinta
Owner. NameCoronel Ent.
�, Permit # . `f •
No: 52-220 Street Avenida Villa r1 Log #
City La Quints zip 92253" Study Area
Tract # Lot # Square -Footage 1461
•1 •ti
Type of Development Single Family Residence No. of Units 1
• 4
At the present time, the Desert Sands Unified School District does not collect fees on ga--ages/carports, covered
patios/walkways, residential additions under'500 square feet, detached accessory structures or replamment.mobilehomes. Its x
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
r '
iXkMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant'to Government Code 53080 in _he amount of
42.05 X 1',461 or $'-2,995.05 'the property listed above and that building"
permits and/or Certificates of Occupancy%for this square footage in chis proposed project may now be issued ,, a
,
. CC/Valle Independent Bank - Ismael •,4.
Fees Paid B '
y Y P t Telephone 235120 rv,
Name on the check
+
- i 'Fill,
• �By . Dr. Dori's Wilson- r
•
Superintendent.
wKA
Fee collected /exempted by, Ellen Patino Payment•Received s,',• $2:,995 O5 � "� `
Check'No. • 235120
Signature
NOTICE: • Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approvalperiod in which you may protestthe' fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid t6the District(s) or to another public entity authorized to
collect them on the District('s)(s) behalf, whichever is earlier. F'
Collector: Attach a copy of county or city plan check application form to district copy for all waivers. ,
�V+t
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt 'i Copy --Accounting
e
i
SALE ESCROW INSTRUCTIONS
THIS DOCUMENT WILL AFFECT YOUR LEGAL RIGHTS RE, AD IT CAREFIJLLY!
TO: COMMONWEALTH LAND TITLE COMPANY ! Escrow No.: 10378KC
72855 Fred Waring Dr. Date: 09/15/00
Suite A5 Page: 1
Palm Desert, CA 92260
(760) 836-3726
Escrow Officer: Kelly Collier
THE ESCROW HOLDER IS COMMONWEALTH LAND TITLE COMPANY WI -HCH IS LICENSED
BY THE CALIFORNIA DEPARTMENT OF INSURANCE.
Buyer, or his agent, will hand you or cause to be handed you upon signing of
these instructions a deposit in the amount of.. .......................:.........$ 1,000.00
Buyer will hand you additional funds prior to closing in the amount of.......... 21.,000..00
TOTAL CONSIDERATION.$ 22,000.00
and any additional funds and instruments .re uired from me to enable you to comply with these
�instr...uctions, which you are to use. on or before October 26, 2000, and.whEn CHICAGO TITLE COMPANY
can issue.a Standard Policy of Title Insurance OW'ners form, with liabilityy of $22-;000.00, on
real property in City of LA QUINTA, County of Riverside; State of CALIF.OP.NIA viz:
Commonly known as: APN 773-274-001-7, LA QUINTA, CALIFORNIA 92253
'Lo't`'22 Block 102.; Unit No. 11,, Tract Santa Carmelita at Vale La Quinta, as per map recorded'in
Book 18 Pages) 't inclusive of Miscellaneous Maps, in the office of the County Recorder of
said county.
4•
Except any reservations of record' of minerals, oil,. gas, water, carbons and hydrocarbons.
Showing title. vested in:
CORONEL ENTERPRISES, INC., A CALIFORNIA CORPORATION.
Free from: -encumbrance except:
A. Current general and special:'taxes for the -fiscal. year in which this escrow closes, and
taxes for the ensuing year, if.any, a lien not yet due or payable.
B. The.lfen of supplemental taxes, if .an assessed pursuant to the prov.isions of Chapter
3.5 (commencing with Section 75) of the Revenue and Taxation Code Df the State of
Call*,forni a .
C. SO, eciaa -improvement assessments,'if any.,.
D. _Easements,, rights, rights of way,.covenants,' conditions, restric
retians and reservations of
cord<
ir-
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)
Distribt,.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 52-220 Avenida Villa
APN 773 -.274 - 001 BIN NO.: CASE NO.: 2000.-367
LEGAL: LOT 22 BLOCK 102 'UNIT 11 S.C.@V.L.Q.
CHECKED BY: Greg Trousdell DATE:
Informl the assigned Building plan checker upon your assignment to this case. . The CDD Executive
Secretary maintains a log book.to track applicationsd assi ri case n bers. .
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review'
Case logged and number assigned
Verify legal and APN information
! I
Consistent with.MDG on file (as.applicable
A
MDG filing required (5 filings since 9/3/98)
with street/surrounding area:
Q0
Gov
c /Consistency
\ 0
Colors
�5
eN
.5 ops
Materials
G Architecture
i
Other Requirements:
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