0204-130 (SFD)U)
I—
(V U)
W
C:) =)
W
CC
�Zt�
CC) O O
H�
w w
~a
U)
Z
Ch
Lr)
N
ON
U °'
4 Q
Z
a 0
LL
X W —
mUU
O
dam
19t Z
ob Z)
r CY
J
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
639961 bi T al;r�2t
Date t' ",�'t' �" Signature of Contractl_LLJ J_�
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).r
( ) 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 STATS FUND Policy No. 1514291TU1
(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 thIat if I should become
subject to the workers' compensation provisions of Secfionx3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: ` -t� �` �' Applicant
" Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above Information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of�this City to enter epon
the above-mentioned property for -inspection purposes:
LS
ignature (Owner/Agent) "�'� ''�-�! Date
BUILDING PERMIT PERI`
VV
-0
g2C1k3-1,V
DATE VALUATION MA x.40 LOT 15 TRACT ULK 1 17 U1 U
�y
JOB SITE
ADDRESSi-J;isaiiCS%!I�i
APN %dT43E�if
OWNER
CONTRACTOR/DESIGNER/ENGINEER
f:1101Z�.Kal FIW
C:ORONM. CC7MMUC".:t'iON
7S-150 C LLETA;MPICO SPU: IT- 4230
78-m L,nax whipyc to imia: ozy3o
LA QMNT.A.
I CA 92W
LA QUINTA CA ri.253
(760)564.4604 X141 220
USE OF PERMIT
R 1I-E.I I►; 4RX: 5 I .lY�C
4n f1 • ,f�N?;:A9ifi t�Oi�S NOTINCLUDE DI-OCK k�AIA, POOL OU DR)V E-WAk°P
TRACT CON3TRi3MON 4,49.2,00 3F
POPIC'tllPsQiTIO 90.0 SI?`
`
Clril2.$ICfWC.A.RPORT 4$3.09 3F
S !Y t 'WOtf D FEINCE 200.011 LF
CONSTRUCTION FEE 301-000418-000 �615ft.0ft
PIAN CHWIX r>< 9 -c1c0 �s $5fJ4i. 53
"M3RO}'��rNMAIL FER 101-000-121.000 01.13
N'LECTR_IC.AL FEF 101 ft0^�G20-:?00 9i3U.9ff
5
PLE. IA 311dcS FRE 101-000-419-0 00 $11%75
STRONO MOT' ON "M - 4i. 212 101-000-241-000 ;9.30
ORAD1140 FRE 101-000,423-000 $20.00
Off'-1V%O11b'H N1PACT FEY, $1,907.00
MKIS9PlAN 101-000-441-345 $10010
F It P, ri+ tpG,f°43 L?$ GbL���! 3 -� V £! 4MONW
&M-'.1l'OT AAL CONE C.'t.?C'7`cON AWD 4 LA1,1' C'TJ!=
$3,,448-06
PRE -PAID MMIS
i & a
4250,00
�r�IRluilI,10RE11;1J :7 NOW
`.�311913 fk
MAY i n
CIT1 i4�Z
YORAQUINTA
FINANCEDEPT•
RECEIPT
DAFT. -E. ,'
By-
DATE FINALED
INSPE TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Slab Grade
_
Ducts
Return Air
Steel
Combustion Air
Roof Deck
+,0 L
Exhaust Fans
O.K. to Wrap
b - 10 - o z _
F.A.U.
Framing
Insulation
` -/ . o Z
/ -0 L -
Compressor
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 �,1 U _
BLOCKWALL APPROVALS
POOLS - SPAS
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
Water Piping
.a?7,, �� lG
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
- Pp , o z
Encapsulation
Gas Piping
Gas Test
. Zs' .p z
Appliances
Final
Final
Utility Notice (Gas)2�"
ELECTRICAL APPROVALS
Temp. Power Pole $-/ 3 . oZ �,'
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 02
Utility Notice (Perm) E -D Z/
COMMENTS:
r
._T K7W" e+ 'r;- r4r --er- �i� =•v^�e-, g�
o�►�`'�� ZGGlw1
4 U
4
LA P.O. BOX 1504
Building 78-495 CALLE TAM PICO
Address LA QUINTA, CALIFORNIA 92253
Owner
Address
City, Zip Tel,
Contractor
Address
City Zip Tel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel,
City I Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I thereby affirm that I am licensed under orovtsions of Chapter 9 {commencing w�(h Section
T00p) of Division 3 of the Business and Professions Code, and my licBnse is in €ul drde .no.
effect. "-� ,t -• t
gJUVATUi9E - _ DATE
�'OWNER-BUILDER DECLARATION
I hereby aTTlipq�go►-I'am exempt from the Conlraclor's License Law for She following
reason; (Sec 7031.5;Hu5kless and PfP1955 pRY Cade: My eNy or wpn+y which requiras a
pumNf fv improve, demoh..h. of rapeir any slrucfdre, prior 1e Its 0suance also
'Vires (he)icanl for such permit to file a aigned statement fhaf he is Acenced pursuant to
the temviawn apof the Contracror's License Law, Chapter 9 (commencing wilh Section 7000) at
avJsion 3 of the Business and ProlessiM5 Code, or Mal he is axempt fhomfrom, and The basis
fal The. alleged e+rempllon, My Wolalian of Sacflon 7031-5 by any Appikant (of u parml-I
suNacla the appacant To a ciNi panalfy, of nnf rare than five hundred dollars 1500).
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, Bussness 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.)
I 1 I, as owner of the p(operly, am exclusively cantracling with Ileensed contractors to con-
strucl the project- iSec. 7044, Business and. Profeaslon5 Cade: Tha Contractor's 11c nsa Law
does rml apply to an owner of property who builds or Improves thereon, and who eanhacfs for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
11 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
r7 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 (E100) 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., 9,, after ntakkrg this Cer ificare of Exemption you should become
subject to the Workers' Carrrpansatlorr provisions of tho Labor Coda, you must forthwith
comply with such provisions or this pemitt shalt be deanwd 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 Nome
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 stale that the above informatlan Is correct.
I agree to comply with all city and county ordinances and slate lows relating to building
constructlon, and hereby authorize representativea of this city to enter the above-
manlioned properly for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
APPLICATION ON
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number
Legal DescriptionUiJc `-7 '
Project Description
Sq. Ft. No. No. Dw,
Size Stories Units
New El Add ❑ Alter ❑ Repair ❑ Demolition ❑
I
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
COnst.
Mech.
Electrical
Plumbing
S.M.I.
Grading 1 r
Driveway
Uz
Infrastru e j
CRY IR
TOTAL
REMARKS
ZONE: � BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback 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
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
r
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 5/10/02
No. 23205
Owner NameCoronel
No. 51-940 Street Eisenhower Drive
city La Quinta
Tract # 117U10 Lot #
Type of Development Single Family Residence
Comments
APN# 773-175-010
Jurisdiction La Quinta
Zip 92253
Square Footage
Permit # 0204-130
Log #
Study Area
1492
No. of Units 1
At the present time, the Desert Sands Unified School District - does . not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square 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
2.14 X 1,492 or $ 3,192.88 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 VIB - Coron6l
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott Payment Received
Check No.
Signature
Telephone
$3,192.88
267075,.
IOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notity.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 District(s) or to another public entity authorized to
ollect them on the Districl:Cs)(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
riuu—cOL—Gb17'L 0:e : 1 1 AM
P. 02
INSTALLATION CERTIFICATE CF -6R
to Address
rrJt Num
DUCT LEAKAGE AND DESIGN DIAGNOSTICS
DUCT LEAKAGE REDUCTION
Pressurization Test, Results (CFM L 25 PA) '77
Test Leakage (CFM)
Fan Flow
1i Fan Flow is Calculated as 400 efm/ton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, enter calculated value here
If fan flow is measured, enter measured value here
Leakage Fraction = Test Leakage/(Measured or Calculated Fan F)ow) =
Pass if leakage Fraction. S 0.06 4r o
Pass Fail
❑ For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM) .
` CHECK AFTER FINISHING WALL: 1
❑ Ycs ❑ No ❑ Pressure pan -test or House pressurization test
❑ Yes ❑ No ❑ Visual Inspection of Duct Connections /V ❑ ❑
Pass Fail
THERMOSTATIC EXPANSION VALVE (TXV)
R"Yes ❑ No
Thermostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
Yes is a pass
❑ DUCT DESIGN
I Yes ❑ No
ACCA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation.~ matches
plans.
2. ❑ Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV,
verified fan flow matches design from CF -1R. '
Measured Fan Flow =
Yes for both i and 2 is a Pass
�✓jr9
0 ❑
Pass Fail
❑ ❑
Pass Fail
1, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in
conformance with the requirements for compliance credit. (The builder shall provide thc'HERS provider a copy of the CF -6R
signed by the builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for
compliance credit.)
Test; -/Signature, Date Installing Subcontractor (Co. Name) OR
Performed v General Contractor (Co. Name)
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at occupancy
Certificate of Occupancy
City of La Quintal
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: SFD
Occupancy Group: R1
51-940 EISENHOWER
Bldg. Permit No.: 0204-130
Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL CONSTRUCTION
l&—
i
Building Official
Address: 78-150 CALLE TAMPICO SUITE 230
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 8-21-02
POST IN A CONSPICUOUS PLACE