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0106-391 (SFD)lF— N U) W O =)co CY Lf)W rl-�r; 6Zr-- (D 0 -- (D0 HCD ~a (7) Z 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 634981 B 01/:31/24 Date 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 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: Carrier Policy No. STATR FUND (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, 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 $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance cf such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 0106-391 TRACT 07/0"ClIc U15214.90 1,2 BLK1.2U12 JOB SITE APN ADDRESS 57.-7M RZYMOAV.1rR D)R)VR 773474-0 OWNER CONTRACTOOR/ DESIGNER // ENGINEER COR014TGJxwI OIN C10 V 131 W19S•RYy10ET 7 8-15 0 CAIATALTA) SCO SiTMPA20 78.150 CA:#' ETAMPIC0 SU Ift30 1 A Q: aftv P. CA 92253 1:...0. (aGTrAirA CA 92253 (760)5.64,-4604 Cn,P.. X- 2261 USE OF PERMIT • DOn.' NOT INCC.UDE.iWC.K l�J.t L.1,, PDOI, OR DRN , WAY APPROACH. Y'Id.ACT C;OHUTRUC:T101f 1,iSs.00 S PORC;EdIPATIO 352A SIF "RAWCAPPORT 808.00 FII' I91S111a l'13.'3M) C0911 OF C°C)Ti6"1RIUC"'rIClN 11.5„814M 00%iOTRUC 1014 n1; 101-000-118-000 S6.n5,50 MLA33 CliK.9 FEE; 101-000-4 39-3 18 �'1•,� 1rr1�i�:aS1`�.' 1t�1. �CSfJt•A3��31 �-$`b'3i}.00 MW,HAN1c:JU, 0EX 101 rODO-421. -000 VILEC."1I$ICIALMS 101.000.42Q1 WO PLUbA81140 FEE 101-000-419-000 $112.00 ' STRONG MOTION M - IYSXD 101.000.241-000 *0111,19 n—RADIVO PE 101-000-423-000 $20.00 DLYEI.OVIM IMPACT M s1, y?.00 PR=s ; P.LAY4 101-000-441.345 $100.00 SUA-"!` )TA,T„ CU'+iMUMO.3' A90 PIAN' CW_7.C1C $3,603.98 1X80 l ,• '}P.ATD k1r', Q 4250.00 RECEIPT DATE BY 10 T AL INSPECTOR o INSPECTION RECORD OPERATION DATE I INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings8 _ _ ©� =� S.T Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck�i�0 _ --VD ! cS % Exhaust Fans O.K. to Wrap Framing ? • Q°?' 9/�/Ol _ S S� F.A.U. 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 _ l'2a( /��% Final POOLS - SPAS BLOCKWALL APPROVALS Steel 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 '' ter Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral_ g7 Pool Cover Sewer Connection/� _ �j ! Encapsulation Gas Piping Gas Test t -i_5. O ( �rT Appliances Final COMMENTS: Finall�Qr Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole .7 --( O- B l S T 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) Of 1-40/-7-5 6 LICENSED CONTRACTOR DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of F- Chapter 9 (commencing with Section 7000) of Division 3 of .the Business and N W Professionals Code, and my License is in full force and effect. O 5 C) License # Lic. Class Exp. Date `'• t--0LO LLJ r- 63-'I 2 i :; �01 r31 /2( Z Date }— Signature of Contractor ...... ' to 0 1r • J F- �' OWNER -BUILDER -DECLARATION W d r-. I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for the following reason: Z ( ) 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). C'') () I am exempt under Section , B&P.C. for this reason LO O N Date Signature of Owner o� d Q WORKER'S COMPENSATION DECLARATION p < IZ I hereby affirm under penalty of perjury one of the following declarations: H p () 1 have and will maintain a certificate of consent to self -insure for workers' X W !:� compensation, as provided for by Section 3700 of the Labor Code, for the O _J Q performance of the work for which this permit is issued. m Q () ( ) I have and will maintain workers' compensation insurance, as required by QU Q Section 3700 of the Labor Code, for the performance of the work for which this 2 L Z permit is issued. My workers' compensation insurance carrier & policy no. are: Cartier Policy No. aoo :5 W TATE FUND D 1,54'W1)-09 Q g (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�,l should become 3 subject to the workers' compensation provisions of Sectyon,3700 of the Labor Code, I shall forthwith comply with thope provisions. ! ; Date: Applicant 7_71- Warning: Warning: Failure to secure-Workers"Compensation coverage is unlawful and _shalt•sob'jec1'9nn 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 the above-mentioned prooerty for inspection purpases. Signature (Owner/Agent) _ ! - ( Dater' BUILDING PERMIT PERMIT,! - DATE VALUATION LOT (I;(ofj_.391 TRACT r' �%•� tri% �.i�.�.4.1�.�) 1,� ]jl� ,2 f" 21 ,`-�.: J1 JOB SITE ADDRESS OWNER CONTRACTOR IDESIGNER/EN INEER CK)Ri311EL (=L3.1v:,I1-.'0GTAC x 7R-•1 .Vii -10 7S-15�L_L_;'J`!N:�tft`TT-E02� 3 ) L4. )C_!)1 hok CA 922:5; ua,()UINT:A C'N 9,2,253 USE OF PERMIT ;,�•7_'. P.l;r:,b1l'1' iJCJF'n� i•i7;' ti•IC:I,'t;;:;4 Ed;l t:'1:;I: i?1.=�L.1.� r}C'I!'•i., C?al ��'1'JUtr`J.�; .A P "•' 4 CJ.A.0 I•t. P0RC;HIF.AII'10 353.1XI S?r 0A P.A(IV(7.A.RP0 R I' O1: P., T1_MA'l-- 00-N;OTTRIUCT)::)1.17YE K1=GC3() Fij-i;)r7[) 3.455,50 :•'Lurid r�StL.C°F:. kT'ii?� I�JI-�1�f:-�.:�:i••.'� �>:1 Y�11.5'1 Fni.il NZI, 0811, 101 1000_4 9 ;) 8 M1i1(,t s N1C.A1, FEE 10).-UC.,0-•42..1-000 ;J0.a0 EL"E"I'TR.I(.'.AL FEF 101 >000-47-0=000 3 is0,09 PLl, 1J11031N'0..?E IC:`1-()()0-Al? %'-.t0 $iIJ(! ;i'I`i;.L)1vt1 ;Ni:J'P1C?" 'FP F!: !?u: 7i.) 101 )(1U ' /1 1 _'•. �iA1f 1 ?I F, I i1'I 0,00-423-011)0 :13G' iip !:)I�:dE.l>; fli'L NPAC" FEF i J!, ;1; 0 IZ 00 ;12'?C11SIR 11LAN 1 L)1 000- .41- 345 11on. i)9 1J1'.=TCJ)'1..��i.. I' �1 �tt::JE'"(`�C:;? I A� -'IT) F'.T_ AI; tr`HEC KI Ili' � 3,60 9 ; - ' _ '� ' ., •u 1 I i ! ..�!�7� k'.tZI�>a'.1�tD .}� i::'H:3 I JUL .,;� 1, C;,t1t! _J -CITY OF LA UUHN'TA f ll�i.;`SCI: Of r'I RECEIPT DATE / ' BY DATE FINALED INSPECTOR MC - - - ,,e1fa11,,, Q"'}+7"'1♦�'ihs+14 I;".'-xMl _'f�;+(�'i= i4^ .r .. 1,"n.+'F. .:�-".'�N"�i %: ,� ..... _ .. w.-..• �..-..e,r: ..- ...r+ - -t -ye" „� OW BOX 1504 APPLICATIO Buildingti 78-495 CALLE TAMPICO Address T•'\��r OIAi.� 1� LA OUINTA, CALIFORNIA 92253 Own r C BUILDING: TYPE'CONST. OCC. GRP. Mailing Address ,Q O� A. P. Number City ('� -}� Zip Tel. �{� .�,.. `n � - Ula `f� �` '. c4 R X53 _ �l�`l 61CH, Legal Description �y� i AA . V S��• -� ���, -%f. <c3�— Coor Project Description ctn Address �.' • � .�.© dig `� � . �(Ity Zip Tel State Lic. City i 8 Classif. 3 Li f 8 `� t Lic. # t� Sq. Ft. [ No. ' No. Dw. Arch., Engr., Size f Stories Units Designer New IN Add O Alter O Repair ❑ Demolition ❑ Address Tel. City^ Zip State 1 Lic. # LICENSED CONTRA • TOR'S DECLARATION Itiereby affirm that I am licen;eli under"yprevisions of Chapter 9 (comment ng with Section ' 7060 of Divis"ion 3 of the a shies an Prbfessions,Code, and my license is in full force and effect. f �— %�/�"/�/ i \ N t/l11 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following •5, reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a T-, permit to construct, after, 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 (8500). 17 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.) I1 1, 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.) I'! I am exempt under Sec. B. 8 P.C. for this reason Date Owner Y 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. O 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.) Icertify 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 abuilding 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 a6iiib 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 aifplicanl —Date- Mailing ateMailing Address City, State, Zip lulnateu vatuau PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Stre lfire/r��f'erfler Side S t >� from Prop�ry Line FINAL DATE Issued by:— Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 Date 7/5/01 No. 22223 CERTIFICATE OF COMPLIANCE APN# 773-174-025 Jurisdiction La Quinta Owner NameCoronel Enterprises No. 51-755 Street Eisenhower Drive city La Quinta Zip 92253 Tract # Lot # 1,2 Permit # Log # Study Area Square Footage 1755 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 garages/carports, covered patios/walkways, residential additions under 500 squarq feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,755 or $ 3,597.75 the property listed above and that 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 - Ish Coronel Telephone Name on the check « By Dr. Doris Wilson Superintendent Fee collected /exe pted by Annette Barlow Signature "vllt� Payment Received $3,597.75 Check No. 246586 NOTICE: 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 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 to the District(s) or to another public enfity authorized to :olleet them on the Districtes)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting F E 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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT Coronel Construction SITE ADDRESS 51-755 Eisenhower 02jr APN 773 _ 174 - -02-Cr CASE NO.: 2001-462 LEGAL: LOT 1 & 2 CHECK AND APPROVED BY: BLOCK 116 UNIT 12 Stan Sawa DATE: S.C.@V.L.Q. 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 Verify legal and APN information Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet of the surrounding area: CVD FOR PROCESSING s ° Colors (DATt) SSI SSIGNEDTO C��f�~ -- Materials (INITIALS) Architectural design features ? e Other RequiremerDsPlanning Commhwkn O City Counci,,. ommunity Oev. Cepa. Initials ..�._..r..w....,�► Case No. - Exhibit Now l wer•....w