0103-204 (SFD)N_ UJ
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LICENSED CONTRACTOR DECLARATION
'dfhereby 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
Date �^�-`�•'=-1 Signature of Contractor_ - ( V
OWNER -BUILDER DECLARATION
f'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.
$i'1AITH PUND 1542937.00
(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.becomvsubject to the
workers' compensation laws of California, and agree that if Ifsho6ld become
subject to the workers' compensation provisions,6f Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: f... r� v, Applicant 1�A--i S..... �1.
Warning Failure to secure Workers' Compensation coverage is unlawful and
,.shall•s`utiject 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
the above-mentioned property, for inspection purposes.
Signature „(Owner/Agent)'`° r �4 "� { r Date4' t T
BUILDING PERMIT PERMIT#
DATE t VALUATION LOT 0103-204 TRACT
)ion(,,.._--- 6i.7i
JOB SITE
ADDRESS
APN
ry"/60 JS'dH.yYryR
32-360
y+yi 2J1*5
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CORONET, COMMtTC1"lC')1<i
CORO:l3EL I ',ONVRLTC7' ON
76-135 0 CALLETA3�r".E IC- SUff=30
78-150177AL E TAWIC0 SLTY'ZM3
uNQT,Tam" CA 92M,
LAQTJWfA CA 92253
(760564-4604 CTIA 22£1
USE OF PERMIT <.>
W1r!- PERMIT 1 1.J NOT 1t�dui� IDE ,BVJC�. 'U�AWq P00% OR DR1VR'�Id:�Y
APPROA.CH. 99' KR, STER PLAN ZF.K'14i45
THAM CONS7',RU ,{10104 1140100 ISIF
PG+f'LCIVAI TIO 36.00 s
i F'!', `0100D PENCE 22010011V
GA RAOF,
ElTr AM Co A• CX' 0)HIMMMON
PYL'it<'tbl X !if .LE MIA MARY
CCxM3'I ITC;' ION 101-000-4) 8-000 160.8:00
KAN cl3'I,( r, Mr.. 101.-000^439-31£3 UTI 17
M.r"CHANICAL 111ZE 101-000.421.000 $33.50
RU;..CTRJOAL FEL 101-000-420-010.0 $125.56
PU6NfAM0 FR;E 1011-M-419-000 41410,71
ST11;OM M.0" 10M FEE - RPSID 101 »000-241" OOD $9.27
GAADT140 FEE 101-000-423-000 $20.00
T. 11n"•111G3XV' IMPACT ME $I.'.)f3"4,.00
MCI=;PT.AN 101•W441.3• 5 $1043.ti0
e
Q
'. n . UCTIO14 AND PLAR QMCK
$3,441.25
LESS IMM -P) rza i 5
$0,00
APR 19 2001
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT
DAT Er f
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�/
Llderground Ducts
Forms & Footings
D jcts
Slab Grade
_ _
Return Air
Steel
Combustion Air
Roof Deck
"-{/��Fj�
�_
Exhaust Fans
O.K. to Wrap
/_�
��%
F.A.U.
Framing
e(
5%
Compressor
Insulation-�Z
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Footings
/_/
�( C
S7
Electric Bond
Main Drain
Bond Beam
a( 3� (
_
S�
Approval to Cover
Equipment Location
N•
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
-�
S
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
S
Pool Cover
Sewer Connection
S �O
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
r
S
Utility Notice (Perm)
Building
Address
T4ht 4 4 "
P.O. BOX 1504
- -N 78-495 CALLE TAMPICO
{ ; LA OUINTA, CALIFORNIA 92253
K
Zip
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Mailing
Address_ Psi `
Ity r
Tel. `1
Coytractor
Address
VS_i_ i.c
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City
Zip
Tel.
State Lic.
8 Classif. `f c
C H� `
City
Lic. q
Arch., Engr.,
Designer
Address Tel.
y..
City Zip ( State I
��- Lic. #t
LICENSEDOCT'I.R'S DECIARONI ns of Chapter 9 (comment �g Ith S ctlonth usinessIons Cr. and rpy license is li.,dW a art:
l5 Ja VI
C11 4-cL
APPLICAT N ONLY
LDING: TYPE'CONST. OCC. GRP. y�3
�t
Number~
al Description
lett Description /
t i
Sq. Ft. ,, t S No.
Size Stories
New ❑ Add ❑ Alter ❑
�VYNER•BUILDER DECLARATION E
1 hereby sill . ih am exempt Irom the Contractor's License Law for the following
reason: (Sec. 703 Business and Professions Code: Any city or county which requires a
permit to construct, offer. Improve, demolish, or repair any structure, prior to 'lts 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 theme oasts
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for•-, permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
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, euisness 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. It. however, the building:
or improvement is sold within one year of completion, the owner -builder will have the burden r
of proving that he did not build or improve for the purpose of sale.) t
IA 1, as owner of the property, am exclusively contracting with licensed contractors to �eon-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's Ucense,La..
does not apply to an owner of property who builds .or Improves thereon. and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I'] I am exempt under Sec. B. d 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1f the permit is for one hundred dollars (5100) 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: It, alter 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. 3087, 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 it work thereunder is suspended for 180 days.
I certify that I have read this application and stale 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 abovtr
mentioned property for inspection purposes.
Signature of adplicant-Date-
Mail
Date
Mailing Address
City, State, Zip
l� —
r
1 No. Dw.
Units
Repair ❑ Demolition ❑
stimated Valuation
PERMIT' AMOUNT
F
Plan Chk:'Dep:-..
Plan°Chic. Bal.
Const
.Electrical
--Pldmbing
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 Street Setback from Center Line -�
Side Setback from Property Line
FINAL DATE INSPECT
Issued by: Date 0' %Y P� - it
Validated by: Q 7 2001 pp
Validation: LA
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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 4/19/01
No. 21909 Jurisdiction La Quinta
Owner NameCoronel Construction Permit # 0 103 -204
No. 52-360 Street Eisenhower Drive Log #
APN # 773-271-005
city La Quinta
Tract # Lot #
Type of Development Single Family Residence
Comments
zip 92253 Study Area
Square Footage 1,485
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
2.05 X 1,485 or $ 3,044.25 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 /exempted by Paula Ruiz Payment Received $3,044.25 1 +
% Check No. 244487
f
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 4-996) 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 entity authorized to
collect them on the DistrictCs)(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
a
04R
RC DISTRICT - PLANNING REVIEW FOR"jj/t��ry
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Res de `iia4)q�
District, 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
SITE ADDRESS 52-360 Eisenhower
APN 773 _ 271 _ 005 BINNO.: CASE NO.: 2001-423
LEGAL: LOT 18 BLOCK 99 UNIT S.C.@V.L.Q.
CHECKED BY: Greg Trousde l l DATE:
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
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:
to
�a
Mate
IArchitecture
��
Other Requirements:('
�Z,
3�
u
Certificate of Occupancy
City of La'Quinta
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: 52-360 EISENHOWER DRIVE
Use Classification: SFD Bldg. Permit No.: 0103-204
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL CONSTRUCTION
Building Official
Address: 78-150 CALLE TAMPICO #230
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 08-13-01
POST IN A CONSPICUOUS PLACE