9704-009 (SFD)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
/Date r, 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),
( ) 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.
(• ) 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.
(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 Califqrnia, 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 1
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 purposes.
BUILDING PERMIT
DATE - VALUATIONI• ltr} LOT
JOB SITE
ADDRESS �s .ts+r .O MOA `' I'.Lvk.0
OWNER
1 ft_
I r,1f 11'W i'A
I USE OF PERMIT
PERMIT # CONTROL #
, i!•• 1il j5% � � 3A
�a
TRACT
APN
77,1 44 1- (NI�
CONTRACTOR/DESIGNER/ENGINEER
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RECEIPT DATE
h'IH.KS IDI' I wt IW
BY, I DATE FINALED INSPECTOR
Signature (Owner/Agent)
Date` -
INSPECTION RECORD
OPERATION DATE SPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVAIX MECHANICAL APPROVALS
Set Backs
unaergrounu uuas
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
POOLS - SPAS
BLOCKWA A PROVALS I
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
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
ELEC
Power Pole
around Conduit
Low VoRage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power j
'PROVALS
COMMENTS:
Final
LINN Notice
ceity, 4 _A& qui'm fa, -1 / U 417 o 0 1
P.O. BOX 1504 APPLICATION ONLY
Building 78-105 CAddress
r LA QUINTACA CALIFORNIAIFORN.92253
% �ti �� � J'%
Owner
Mailing
BUILDING: TYPE CONST, OCC. GRP.
qq
Address �� ,. � �Yf/Z'. ve /c; S` ( A.P. Number
City _ Zip 7 r 7 Ted
it fJy; t%j �G 1 �� �c�—I - �l Legal Description
Contractor I_
i2 Gr7 -e l c � � > ; At.�C-� 'r i
Project Description
Address
Giyyy / Zips 1 Tel
7 �
State Lic. ,, City
e
& Classif. �L r �i r" !f Lic. # Z1 t / Sq. Ft. C - No. No. Dw.
Size Z r! L Stories Units
Arch„ Engr.,
Designer New Cb/ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel,
City Zip State
Lic. #
f : LICENSED CONTRACTOR'S DECLARATION
I er by affirm that I am licensed under provisions of Chapter 9 [commencing with Section
f Otvislorl,3 of the Business and Professions Code, and my license is to fptl, foroe•and
to f t. r
i
SIG rA unr _ OATE
1 OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the fallowing Estimated Valuation
reason: (Sec- 7031.5,Business and Professions Code: Any city or county which re00tras a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the appf c nl for such permit to file a signed statement Ihat he is licensed pursuant to PERMIT AMOUNT
the proviseons of the Contractor's License Law, Chapter 9 (commencing with Section 70001 of
Division 3 of the Business and Professions Code, or that he is exempt therefrom, and the basis
Or the alleged exemption. Any wolafion of Section 7031.5 by any AWcanl for a permit Plan Chk. Dep,
sub)ecfs the appl=nl to a civil penalty of not more than five hundred dollars (3500).
[] I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COnst.
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, Mech.
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 Electrical
of proving that he did not build or improve for the purpose of sale.)
I I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strurt the project. (See- 7044, Business and Prolesalons Coda: The Contractor's license Law
dons not apply to an owner of property who bWlds or knproves fhamon. and who ronftacts ter S.M.I.
such projects with a ccntracWrfs) kcensed pursuant to the Canlfaclor's [lcense Law.)
Grading
I l I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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
7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) 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 Cal iforn I a"
Date Owner
NOTICE TO APPLICANT: If, after making Ihfs Carflficafe of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback fromter Line
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.) Side Setback from Prope Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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 t that have read lhlt application and state That the above information reftagis correct. Issued by: _Dale POr
I agree to comply with all city and county ordinances and slate laws relating to building
constructlon, and hereby aufhofi7e representatives of this city to enter the .above.
menllaned properly for Inspectlon purposes. Validated by:
Signature of applicant Date -
Mailing Address Validation:
City, State, Zip
BUILDING DIVISION I CITY OF LA QUINTA
CONSTRUCTION ESTIMATE
NO.
j ELECTRICAL FEES
NO.
PLUMBING FL
1ST FL. SO FT ;_
2ND FL. SQ. FT. (<G
POR. SO FT
GAR SO FT. (iT
CAR P SO FT r.�p
WALL SO FT rg
SO. FT dr
ESTIMATED CONSTRUCTION VALUATION
S
UNITS
YARD SPI<I_fl SYSTEM
_
MOBILEHOME SVC
BAR SINK
f
fPCVjER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
I
URINAL
$
WATER PIPING
NOTE: Not to Le used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN
SINK
ABSORPTION SYSTEM B T.0
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.0
SO FT, ' c
BATH TUB
SQ. FT, (, c
WATER HEATER
MAX, HEATER OUTPUT, B.T.0
SO, FT. RESID (;, 1Ls c
SEWAGE DISPOSAL
SO FT.GAR Via; 3,%c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST, FEE
ELECT, FEE
SMI FEE
PLUMB, FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd,
$ plus x5
=$
LUMBER GR
FINAL INSP
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
prmfl.r FINAI
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 6/4/97
No. 15598
Owner Name Ismael Coronel
No, 51340
City La Quinta
Tract #
St ... t Avenida Velasco
Lot #
Type of Development Single Family Residence
Comments
APN # 773-091-005
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area 113
Square Footage 1290
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
1.84 X 1,290 or $ 2,373.60 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/Coronel Enterprises, Inc Telephone 564-4604
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,373.60
Check No. 141454
Signature
MTICE: Pursuant of Assembly Bill 3081 (CHAP 649, STATS. IMX) 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 dale on which the bullding or Insiallatlon 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 Dlstrlct('s)(V) 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
RECORDING REQUESTED BY:
ORANGE COAST TITLE COMPACOMPANY
96.5787KC R-151224-1
WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
ISMAEL B. CORONEL
and MARIA M. CORONEL
51-755 Avenida Velasco
La Qtiinta, CA 92253
196834
RECEIVED FOR RECORD
AT 8:00 O'CLOCK
MAY 2 919%
PAID
HlCOltlltl NI UlGaai necorc, r
Doc. "transfer Tax of Rvr. sdeCowry.Gal+wrwa ! _
FRANK K JOHNSON � Recorder �t �
Riv. Co. Recorder gees 5
_ I
SPACE ABOVE THIS LINE FOR RECORDER'S USE
G*ANT DEED
The undersigned grantor(s) declare(s)!
Documentary transfer tax is: $9.90 ,
lXXX Cor".prited rill f1l.17 vali.t6 of nron'erty cone-ed or
Computed on full vale less liens -and eucumbrances
Unincorporated area: ( ) City of
FOR A VALUABLE CONSIDERATiJeiDt of which is hereby
APN: 773-091-005
-Mk , OZO O)
remaining at time of sale.
. and
acknowledged,
STANLEY I. COHEN and ADRIENNE D. COHEN, as Trustees of The 1992 Cohen Revocable Living
Trust, u/d/t July 21, 1992
hereby GRANT(S) to
ISMAEL B. CORONEL and MARIA M. CORONEL, husband and wife as joint tenants
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 5 IN BLOCK 63 OF UNIT 6, SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN
BY MAP ON FILE IN BOOK 18, PAGE 67 OF MAPS, RECORDS OF RIVERSIDE COUNTY,
CALIFORNIA
Dated May 16, 1996
State of California
County of Lv S S ..S.
vu
before m c,L S
personally appeared
�+ M1
F.
�- (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(s) i-/are subscribed
to the within instrument and acknowledged to
me that 1�kc/they executed the same in
ha.-.Ater/their authorized capacity(ies), and
that by h4-e�/their signature(s) on the
instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed
the instrument.
WITNESS my han and official eal.
Signature
MAILTAX STATEMENTS TO:
STANLEY . COHEN, �Trus�tee
A R NNE . COHEN, Trustee
(This area for official notarial seal)