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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. f
License # Lic. Class Exp. Date f
Date's � ` 7 Signature of Contractor _11�-`) t
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).
( ) 1, 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.
�Q) 1 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 gTA-0 jiq,,1MPolicy No. i%2,""1
(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 becom se object to the
workers' compensation laws of"California,=and agree that if 1i should become
subject to the workers' compensation provisions of Section 3700,4of the Labor
Code, I_shall forthwith comply withthose provisions.
Date: 1 -2 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 upon
the above-mentioned property for inspection purpo`ses.
j ! f
Signature (Owner/Agent),T LO
Dated
BUILDING PERMIT PERMIT#
%`• �'
020 -M0 -M
/
DATE VALUATION $ ;i
f /)..... , . TRACT 13.fz3C1i4���
JOB SITE
ADDRESS r,�l 11 i 1� � i t e
APN
773.301-M
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MAR A.iiOURZ
CORO1+Tt%C0N97.`.R'It3' n_1.0N
11.235 001a''T98 AVE
79.150 CALLA T,001 Sl'1iTEftiO
Li NWOOI'i CA
IAQTJr+I`rA Cr'A. 9142253
(70�56+4604 CRU 2261
USE OF PERMIT
MINGLE FAi'� Y DWELUNG
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��p��y�yl!:►��p //��Ayylr�n gal�e�eayV.�$�:>f��a+><'a
ltffiSJCtiA/ti1..Pi,�n 9 1+�A F,
tl
a �.
IW(V f� p'q.*�yp�{�v�y l�s�p3 y�,p * $ d� ��y��1
AAF1l ( J!. NWl`F l �4u t`�.)N 3,.J !Y.4�/ t ii 1
RCIVPATIO ",00 S��Cljy
F LAQUJHTTA0AIA
i�Cr�H"�AAt 44+ M �i�AN_
CEREPT.
A°.fTJ'A,77YlLP.''1.f1,IEW) (WJr OJl1 a,rl. A S7XvS &r_T.0N
92133-11-150
summkRy
1 ” ' F'rii,.��f.Qq?IT,I
tC'tO,3,�ySI.. vt2.�Lr*91"11"rl17INpg3 �1y /iy31-6.1PL��-� ry�p 6} �p
dSr4rA \.wi.�,f C.K FAFU A4!•.�°W{F,+-439-.31Ni S505'.!1
M 13A'XM'1` 9.O1 -I -09-318 -325&00
10CHANWAL FEE 103.-0,0-10 1x000 slsfl.i0
B1XC31U »A'f,31'PA 101-4".�3U-420-Wi1 $310.414
FIAM91 OPHE' fs0l4*01*4g166'S((�^i?���► $3.18.00
N�6vRV3IG lel' 47R11i.TAO d'17 Z 4 WS.W 101 -OM -241 -IM $9.2.4
G1dADi10TCIPRE 1014KIO-423.000 $20.00
a
13n=WUR IMPACT VFV s,9.'M1.0D
101. 41-345 $100.00
SUB -TOTAL C'M./9S'1 R I i XY AND PLAN
�9.7c�"F4ae•99SwYM�,
1gp�&97.�AL'"�88.��K ly7,y,��,t
JF✓ . tg P7! E-d�l` LD) FRU
e89
250.00
RECEIPT
DATE ;
By'
DATE FINALED
a2
INSPEC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
nderground Ducts
Forms & Footings
_ _
Q T/
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
-O?—
Exhaust Fans
O.K. to Wrap
-y- / -0 2--
F.A.U.
Framing
47
Compressor
Insulation
- p_2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
'
Final
Final - v2 _
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
Ae
-4' ft
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
7 -p
Encapsulation
Gas Piping
Gas Test
Zee
Appliances
Final
Final
Utility Notice (Gas) �' -U
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 5 �3 .(� e>_ _
Final
Utility Notice (Perm)
COMMENTS:
,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 5/21/02
No. 23234 Jurisdiction
Owner NameMaria Gomez
No. 52-550 Street Eisenhower
city La Quinta zip 92253
Tract # BLK144U15 Lot # 21
APN# 773-301-003
La Quinta
Permit # 0203 -003
Log #
Study Area
Square Footage 1.518
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 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 1,518 or $ 3,248.52 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 V1B - Coronel, Construction
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature
Telephone
Payment Received • $3,248.52
Check No. 26710,9
40TICE: Pursuant to 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
rbove 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 District(s)(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
eU�� �'?0
RC DISTRICT - PLANNING REVIEW FORI VQ lrez) ;
This form is to be used by CDD staff for review of single family dwellings in the RC i6q-9,ve
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 52-550 Eisenhower Drive
APN 773 - 301 -
LEGAL: LOT
003 CASE NO.: 2002-625
CHECK AND APPROVED BY:
.BLOCK 144 UNIT _15 S.C.@V.L.Q.
Greg Trousdell
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/CORREC ION
Verify legal and APN information
F\e
e
Consistent with MDG on file las
/
applicable
b
gs\o� •t/,/
MDG filing required (5 filings since
,
\n
0a eO-
9/3/98) _
�i
C
'°
Architectural variety within 200 f
k -
the surrounding area:
le
a N9
Colors
W►th Go
/
L Materials
Architectural design features
Other Requirements:
G.
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: 52-550 EISENHOWER DR
Use Classification: SFD Bldg. Permit No.: 0203-003
Occupancy Group:
R3
Type of Construction: VN Land Use Zone: RC
Owner of Building: CORONEL CONST
Building Official
Address: 78-150 CALLE TAMPICO
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 11-14-02
POST IN A CONSPICUOUS PLACE
NOV-08-2002 09:55 PM
INSTALLATION CERTIFICATE CF -6R
tr Addr•ct5
T
DUCT LEAKAGE -AND DESIGN DIAGNOSTICS
t_DU_CT_LEAKAGE REDUCTION
1'rc)aur:xution'i'csi Krsults (CFM Cry 25 PA)
Test Leakage (CFM) _Z7
F;III flow
It' F:rr Fu\� is Calculated as 400 cfttVton x number of tons, or as 21.7 x Heating Capacity
in Thousands of Btu/hr, enter calculated value here
1£ fan flow is measured, enter measured value here
Leakage fraction =fest Leakage/(Measured or Calculated Fan Flow) —
Pass if leakage fraction <_ 0.06
/Z
❑
For AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed:
Duct Fan Pressurization at rough -in measured leakage (CFM)
:11,141t FINISHING WALL: l
❑ Ycs ❑ No ❑ Pressure pan test or House pressurization test /
❑ 1 cs ❑ Nu ❑ Visual Inspection of Duct Connections
_ THERMOSTATIC EXPANSION VALVE (TXV)
�� �•, ❑ Nu Thennostatic Expansion Valve (or Commission approved
equivalent) is installed and Access is provided for inspection
Yes is a pass
❑ DUCT DESIGN
1 ❑ ,s ❑ �t� AC:CA Manual D Design calculations have been completed,
Duct Design is on the plans and duct installation matches
plans.
❑ 1• ,s ❑ :�u TXV is installed or Fan (low has been verified. If no TXV,
verified Can (low matches design from CF -1R.
Measured Fan Flow a
Yes for both 1 and 2 is a Pass
Nllq
❑ ❑
Pass Fall
Pass M}
❑ ❑
Pass Fat,
1. the Lmdl (sisncd, verify that the above diagnostic test results and the work I performed associated with the tests) is in
COP 1,01,011 lice With the requirements for compliance credit. (The builder shall provide the HERS provider a copy of the CF -6R
;,L:)CL! b ' V thr builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for
;i}rttipit2ncc cre..dit•j
Zj
I'cau, SiLriattlre, Date Installing Subcontractor (Cu. Namc) OR
Pv; luithcd General Contractor (Co. Name)
COM, F0 liui'.ding Dcparttttent
FI[:*Ry Provider (if applicable)
Bul•i.ng Owner at Occupancy