9511-059 (RPL)- ` LICENSED CONTRACTOR DECLARATION
J hereby affirm th
N at I am licensed under provisions of Chapter 9 (commencing., with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
co License is in full force and effect. n 74+�
r` W '' License # LIC.-Rd's"I 13 Exp. Date / 1 106
r` � r' ` art,.,
r` � / Date 1A : Signatureof Contractor "�
r'00r
cp H OWNER -BUILDER DECLARATION
J IU 1 hereby affirm that I am exempt from the Contractor's License Law for the
CL following reason:
U) ( ) I, as owner of the property, or my employees with wages as their sole
Z 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
co Date Signature of Owner
inN
OU rn WORKER'S COMPENSATION DECLARATION
CL Q I hereby affirm under penalty of perjury one of the following declarations:
g Z () I have and will maintain a certificate of consent to self -insure for workers'
0 HO compensation, as provided for by Section 3700 of the Labor Code, for the
X w LL. performance of the work for which this permit is issued.
0 J _J () I have and will maintain workers' compensation insurance, as required by
07 Q U Section 3700 of the Labor Code, for the performance of the work for which this
p U permit is issued. My workers' compensation insurance carrier & policy no. are:
d to Carrier Policy No.
? ? (This section nee noftb completed if the permit valuation'ieG $100.00 or less).
r- () I certify that in the performance of the work for which this permit is issued,
Q I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, 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 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 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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.
��,cerdfy 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
onstruction, and hereby authorize representatives of this City to enter upon the
• , ove-mentioned property'forinspection purposes.
a /
Signature (Owner/Agen1U_� f 1/,/ Dats"�!-� 11?2;>
Y
L.I
ALCM
BUILDING PERMIT
PERMIT*
DATE
VALUATION $8� .(II? LOT TRACT
JOB SITE ADDRESS
APN
51-546 FISUtiHOWER OR.
OWNER
CONTRACTOR
C�ORONEL, CONSTlttlflT° ON
P p !1
P:1;�1,i.;,4�ii:ul1:iJtf�a.e+EA�r
6A IN"11D.P.IMM I"03MA#�
7i17 `
77836 AVENIDA .MON'IE7.,l1.h1A #
LA. QU11Vr . CA 92253
1.,A QUINTA CA 92253
DESIGNEWENGINEER
(01 )561-1604
USE OF PER'DO IJ AN Di0R SPA
POOL AND SPA. Y REAR YARD SJ?1*8AC.X Rki. )Ct'LON APPROVEDPFRSBA-95-361,
FEE DESCRIPTION
FEES
POOL ANOIOR SPA 8.,500.00 LS
0Vr1MWVFCJ) COSI' O1C CONI S'TRUf.'' 10NI
9,500.00
PliltNitIT F. -KE, SUMMARY
PIAN CHEM F..W 101-000-439-318 $70.20
CONSTRUC.710�iFEE 101-0.00-415-000 $108.00
14tF'C[ VN1CAL FEE -- POOL 101-0 0-4271-DOO $211.W
ELECTRICAL, FE, E -- POOL 101-000-4.20-000 $45.00
PLU NIAING 170-3 -- POOL 101-000-419-000 $29.00
11D
� 0
' { M
V 15 1995
RY
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
5274-.
LESS PRE -PAID FEES
$0.00
TO A1,1'ERMIi' FEEN uUC INOW
$27410
TOTAL PROJECT "1tM.a.T FEES
274,20
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
�2
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
, ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
9,
5-PAMMM£DMSUE5-
ZV!-y/-5-r EETx:.70�ijz k
6)t'1-S7-1WG 01 -JC.< WALL 6'.
514
t._el
-'el
00
PA
Mt
POOL AREA TO pf:-
ALL r,413,f
AND
51 -.,y�Q_-S61V Q WEW-�>X-
. __6
-
FV L A UO"U INTA
J
A
B UllU'D ", SAFETY DEPARTMENT
CONDITIONALLY
ACCEFrf ED FOR CONSTRUCT1,0H
NES
AND ALL APPLICABLE COD
BY
DATE'-
LICENSED. CONTRACTOR DECLARATION
,$ eF�: affirm under penalty of perjury that I am licensed under provisions of
c Cnapter'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
3a9�!
vDate' rr'' 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:
( ) 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 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 ' '
Chereby 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•.(or by Section 3700 of the Labor Code, for the
performance of the work for wA ch this permit is issued.
(X, I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, foie performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No. +
CAX.' &1�1 T ArLF IN3. - NWC42ISPAI
('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 California,. and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, f shall forthwith comply with those. provisions.
,/Date: -Applicant—
Warning:' Failure
ApplicantWarning:'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 onhis
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
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) !n==1 ""^ Date 1114-YA ie"
•
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 99711-070 TRACT 6279
11 /24M $.00
JOB SITE
APN
ADDRESS
51-W USENHOWER DME
OWNER
CONTRACTOR / DESIGNER! ENGINEER
ESEQUIEL CORONEL
CORONEL CONSTRUCTION
P.O. BOY 389
P.O. BOX :389
Uk QUINTA CA, 92253
LA QUINTA CA 92253
(760)564.4604 CBL# 2261 '
USE OF PERMIT
A,f i Cf`
REPLAMENT POWIT FOREaXPIRP").t PERMTP #95:11-059 TO COMPLUTu.
FOOT, .AND SPA.
ESTI :IMA C, D COST Of' LO1. STRVC110IN
16,ttb
PEEtM!"t FEESUMMARY
CONSTRUCTION FEE 101 "000-413.000 $10$.010
NJECHANICAL FEE ^OWL Ii101-000.421-000
MEM.R.ICAI, F -- :POt41w ` 101-000-420-000 $45.0.0
PLUMBfNQ F1 E.—POO � IQI<t�i1-AIJ-Q()0 $V,00
PAID
- NOV 2 4 1997
I VIIIi T OFLAOiUN1'A
`
SUB -TOTAL CONS1 Oc ON AND PLAN CHECK
$204,(0
LESS PRE-P.All) FEES
ff $0.00
TOTAL: PERM..iT FEES DiYP_ NOW
$204.00
RECEIPT
DATE
BY
DATE FINAL ED
INSPECTOR
r 1
R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
a BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
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 8 Controls
Party Wali Insulation
Condensate Lines
Party Wali 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
_-
Under round Pibg. 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
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
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: