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9701-061 (AR)LICENSED CONTRACTOR,DECLARATION:' reby.affirm und&-penalty of perjury that) am licensed underprbvisions,df,. . p'qr,9(66mmoncing with Section ,7 000) Of Division 3 of the Business and ;%i6Aa,ls Code, and'my License is in idll force and effect. sense #-, Lic. Class . Exp. Date,'' 'o_ Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exem pt, fromjhe" ontractors License Law for the following reason::.- :4.A 1, as owner of, the property, or my employees with wages. as their sole . compensation, pensation, will do the work, and the structure is not intended or offered.1for s'alo:(So-6'.:`1044; Busin&ss,&,ProfesSd .*i6nals Coe). XY 1, -as oi�neir-of the property, with exclusively'. contracting . lice'ns6d �contractors to construct the project (Sec. .7044, Business & Professionals Code). O I am exempt under SectionB&P.C- for thli&reason Date 1-7 Signature Of;-. O -w, her rtl� L'.. J WORKER'S COMPENSATION DECLARATION I. hereby aff irrh 61 der penalty of perjury one. of LhaVe and the following decla�ations: �'�Il maintain ai.cortificate of'consent I to self -insure for worke r rs' W 'compensation, as provided, for by Section 370.0. of the Labor Code, for lhb performance of the work for Which this permit is issued. T have and will maintain workers' compensation insurance, as required by Section 3700,of the Labor Code, do, for the performance of the work for which this permit .'is. issued. -.*Ay, workers" 69rnpensatiod. insurance carrier & policy no. are: Carrier, Policy -No. -(This section need not be completed if the permit valuation is for $100.00 or less). ,Alcertify.that in the performance of the . work for which h this permit is issued. I shall not employ any person in any manner so as to become subject to the 'workers' compensation laws . bf California, and agree that if I -should become „subject to the Workers' compensation, provisions of Section 3700 of the Labor . ode, I shall forthwith comply wit h4hose provisions. Date: 8 -3 ; JI Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and , . shall subject an employer to criminal penalties - and civil fines up to $100,000in 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 here -by 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 '&'hoI0)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 thb.�bove-mentioned property for inspection purposes. /j igriature- (Owner/Agerit) Date 'CONTR�01_# PERMIT# BUILDING PERMIT 4735 DATE VALUATION LOT' TRACT JOB SITE ,ADDRESS 51-4,90 AVE N10A 00REGON APN 773-31&024 OWNER CONTRACTOR I DESIGNER ENGINEER RU SSrt 1A, 'NY & RE tl.EICC, A, W11. UP, MOIER! BUIL"Orl'A (,A 922X3 USE OF PERMIT 496' &f-'. A01WL, IWDYHON. TRACT CiDNSIRIX.M(A� 4 9 6 silk) S 1.4 L STI 'D CM'i'CONSTRUMON TW.. REIRAUT, PEP, SUMMA.-ift, C -PLAN CH12CK PPE 101-(300-439-318 $172.251 CONSIMIUCT10,14 I.*37t 101 -OW -419-000 $255.m. NRYI-11W.VVICAL, ME 101-000-42J-000 V. 1. 51.) 0,E,, CTRIC'At,FICE 0 1 A )G4420 -ft) $3 .36 STOMI A4CA'. t(5*N F'bt,' - ",151,1). 101-000-2.41-000- 0 R MAN0,11 -If" 4)0 PLAN C,.HFUIC LEE g5 PIRLE-PAID At, PERNIII'VE&S OVE NOW zu,93tio: CY) C CIZ o LL 0 $523.if . P Koo 5523.80 RECEIPT RATE BY DATE . FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts 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 2 Final 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 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 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 i&Temp. Use of Power Final Utility Notice (Perm) Desert Sands VnifiedSchoolDistrict Notice: 82-879 Highway 1:11 Document Cannot Be Duplicated Indio, ,CA 92201 619-775=3500- CERTIFICATE OF COMPLIANCE Date 2/26/97 ARN # :773-315' 024 No. 15286 Jurisdiction La Quinta Owner Name Russell White Permit # No. 52790 Street Avenida Obregon"' City La Quinta zip 92253 Tract # Lot # Square footage Type of Development Residential Addition, Comments Log # Study'Area 112 496 No.. of Units 1 At the present time, the :Desert Sands Unified School District does> not collect=':fees on garages/carports, covered patios/walkways, residentiaLadditions under 500 square feet;detache''d accessory structures or replacement mobilehomes. It has been determined the' above-named owner is exempt; from:pay>ng school fees .`at -this time due to the following reason: i. . Residential Addition 500.Sq'Feet-,or Less.. :-EXEMPT This certifies that school facility fees imposed pursuant to Governmenf Code 53080 in the amount of 0.00 X 496 or $ 0.00 ` .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 n/a J'elephone 56.4..-5047 Name.on the check By Dr. Carol McGrew Administrator in Charge `. Fee collected /exempted by Pauline Pearson Exempt '� �0=0.0'•, Check No. n/a Signature ` NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify youlhet the,90 day approJaf period in which you may; protest the tees or other payment identified will begin to run from the dale on which the building or installation permit for this project isue sssd or ori ey which,tfare paid to the District(s) or to another public entity authorized to tolled them on the Districl('s)(s') behalf, whichever is earlier. 4• Collector: Attach a copy of county_or city plan. checkapplication form ,to district copy for all waivers. :.', Embossed Original- Building Dept./Applicant •Copy Applicant/Receipt: Copy - Accounting A; FEB -28-97 04:16 PM P..02 HOMEOWNER POLICYCENTil CENTURY -NATIONAL INSURANCE COMPANY CALIFOR'NIA AcIiiilItmllStock :;6i*nY W "DEAATIONS 12200 SYLVAN STREET,.'� HOLLYWOOD, CA 91606 BENE ► M' NOkTH: WAL CERTIFICATE WUTEP,N GENERAL A064CY ..NoXg C."EA pIVIglog AGENCY BILL POLICY,'NUMBER 2068924 YPt7R-.AGl:NT' IS: NAMED WHITE, RUSSELL�W & PATRICIA A INSURED DIRECTORS INS, SERVICE O:'; Box RlVkR'SIDE CA PROPERTY 52790 AVENIDA OBREGON 925:0'2` p ADDRESS LA QUINTA, CA 92253 (6,60) 327-2885. POLICY TZRM; CONTINUOUS FROM 05/31/94 '(12:.01 AM LOCAL; TIME) UNTIL -,CANCELLED OR NONRENEwED INSUFLAACR 16 TO BE PROVIDED ONLY WITH RESPECT TO THE LOCATION(II) AND/OR COVERAGEISIR FO WHICH A LIMIT OF LIABILITY 18 SPECIFIED. SUBJECT TO ALL C81MITIONA At TUIR 8^1 ift- SECTI.ON I - PROPERTY COVERAGE LlMrr8 A a c D SEPARATE PERSONAL DWELLING STRUCTURES PROPERTY LOSS OF USE $103,000 $10,300 .$72,100 $41,200. SECTION 11 - 00 ILITY COVERAGE LIMITS E F PERSONAL MEDICAL PAYMENTS :,LIABILITY TO OTHERS 93A0,000 $11,000 EACH OCCURRENCE EACH PERSON #7 SuBjEcr TO THE FOLLOWING FORMIS) AND ENDORSEMENT(S) ATTACHED AND/OR REVISIOMS) INCLUDED, MADE PART OF THIS POLICY AT THE TIME OF ISSUE; COVXRAGES FORMS 4R I ZHIUMS SPECIAL FORM - HOMEOWNERS POLICY WO H0300(7/91) BASIC:,COVERAGE $508,00 LENDER'S LOSS PAYABLE ENDORSEMENT 430BFMS(5/42) REPLACEMENT COST COMPOSITE WO H0301(7/9i) FIRST MORTGAG23 LN # 7113749 NORWEST MORTGAGE INC. ITS SUCCESSORS A/0 ASSGNS. P.O. BOX 12011 RIVERSIDE, CA 925022211 DIRECTORS INH. SERVICE P.O. Box 1489 TO I RIVERSIDE CA 92502 SECOND MORTGAG33 N 0.- N E MAYRA WfViELI Symbols Numbering System AGeneral Safety Notes PLATE LOCATION AND ORIENTATION Failure to Follow Could Cause Property 13/ * Center plate on joint unless Damage or Personal Injury dimensions indicate otherwise. Dimensions are in inches. Apply 1. Provide copies of this truss design to the plates to both sides of truss and building designer, erection supervisor, property �e is securely seat. J2 J3 J4 TOP CHORDS owner and all other interested parties., _F�, 2. Cut members to bear tightly against each 9 Y 9 17-1 �, other. 0 WEBS J5 3. Place plates on each face of truss at each * For 4 x 2 orientation, locate 0 2:3 , Q �' ; joint and embed fully. Avoid knots and wane from outside edge of plattruss 0 o_ a �y u at joint locations. a d truss and vertical web. a o 4. Unless otherwise noted, locate chords laces p' I/4 at panel length(' 6" from adjacent joint,) �, BOTTOM CHORDS _ *This symbol indicates the 5. Unless otherwise noted, moisture content of required direction of slots in J1 J8 J7 J6 lumber shall not exceed 19%at time of connector plates. fabrication, 6. Unless expressly noted, this design is not applicable for use with fire retardant or JOINTS AND CHORDS ARE NUMBERED CLOCKWISE preservative treated lumber. * For tabular plating format refer to the AROUND THE TRUSS STARTING AT THE LOWEST JOINT 7. Camber is a non-structural consideration and MiTek/Gang-Nall Joint/Plate Placement Chart. FARTHEST TO THE LEFT. is the responsibility of truss fabricator. General WEBS ARE NUMBERED FROM LEFT TO RIGHT. practice is to camber for dead load deflection. PLATE SIZE 8. Plate type, size and location dimensions shown indicate minimum plating requirements, The first dimension is the width 4 4 to slots. Second CONNECTOR PLATE CODE APPROVALS 9. Lumber shall be of the species and size, and X perpendicular in all respects, equal to or better than the dimension is the length parallel grade specified. to slots. BOCA 86-93, 85-75, 91-28 10. Top chords must be sheathed or purlins LATERAL BRACING HUD/FHA TCB 17.08 provided at spacing shown on design. Indicates location of required 11. Bottom chords require lateral bracing at 10 continuous lateral bracing, ICBO 1591, 1329, 4922 ft, spacing, or less, if no ceiling is. installed, 401" unless otherwise noted. SBCCI 87206, 86217, 9190 12. Anchorage and/or lood,tronsfer•ring WISC/DILHR 870040-N, 930013-N, 910080-N connections to trusses are the iespdr sibility of BEARING others unless shown,."' Indicates location of joints at 13. Do not overload. roof or floor trusses`with� which bearings (supports) occur. stacks of construction materials, -- TM 14. Do not cut or alter truss member or plate without prior approval of a professional, engineer. MITek Industries, Inc. ® TM 15, Care should bei -exercised in'handling, ., erection and installation of1russes, PANECLIP` © 1993 Mitek Holdings, Inc:, .:;.r='" HYDilO,A/R® FORM01 8,019 Gnn�G-wu� FEB -28-97 04:16 PM P.02 HOMEOWNER POLICY CENTURY-NATIONALINSURANCE COMPANY CALIFORNIA A Capl.tqil Stock Company . DECLARATIONS 12200 SYLVAN STREET NORTZ HOLLYWOOD, CA 91606 RENEWAL CERTIFICATE (818)766-6500 WUTMN CfNgM,L AC&CY - J40MUWNn olvISION AGENCY BILL POLICY NUMBER. 2068924 YOUR AGENT IS: NAMED WHITE, RUSSELL W & PATRICIA A imsum DIRECTORS INS, SERVICE P.0 .Box 1489 RIVERSIDE CA PROPERTY 52790 AVENIDA OBREGON 92502 '* ADDRESS LA QUINTA, CA 92253 (800127-28'85 POLICY TERM; CONTINUOUS FROM 05/31/94 .(12:01 AM IOCAL TIME) UNTIL CANCELLED OR NONRENEwED INSVRANCe 16 TO BE PROVIDED ONLY WITH RESPECT TO THE LOCATIONIS) AND/OR COVERACIE16) FOR WHICH A LIMIT OF LIA814T'y 18. SPECIFIED, . SUBJECT TO ALL CONDITIONS Of THIS POUCY; SECTION I - PROPERTY COVERAGE LIMITS A 8 C D SEPARATE PERSONAL DWELLINd STRUCTURES PROPERTY LOSS OF USE $103,000 $10,300 $72,100 $41,200 SECTION 11 -.LIABILITY COVERAGE LIMITS E IF -PERSONAL MEDICAL PAYMENTS LIABILITY TO OTHERS 000,000 $1,000 EACH OCCURRENCE EACH PERSON .... ........ 1. SUBJECT TO THE FOLLOWING FORM($) AND ENDORSEMENT($) ATTACHED AND/OR RFVISIONIS) INCLUDED. MADE PART OF THIS POLICY AT THE TIME OF ISSUE; COVRRAGES FORMS. PREMIUMS SPECIAL FORM - HOMEOWNERS. POLICY WO H0300(7/91) BASIC COVERAGE $SOB . oc LENDER'S LOSS PAYABLE ENDORSEMENT 430BFUNS (5/42) REPLACEMENT COST COMPOSITE WO H0301(7/91)' FIRST MORTGAGEE LN # 7115749 NORWEST MORTGAGE INC. ITS SUCCESSORS A/O'.ASSGNS P.O. BOX 12011 RIVERSIDE, CA 925022211 . DIRECTORS INS. SERVICE XKTL P.O. Box 1499 TOC. RIVERSIDE CA 92502 52COXV MORTGAGES MAYRA LOMELI,' A .... ...... 02 0/282 C0 701oias N161,104 2 A CITY OF LA ,QUINTA SUB-LIST :ONTRAC OR ADDRESS. _ )WNER USS�LL. k4iJ� C W tJOB-ADDRESS 6 d 'his form shall be posted on the job with the Building Inspection Card,ai� all-times'in•a conspicuous place. is the responsibility of the General Contractor or the Owner/Builder:to monitor the?"sub-contractors that re on this list are the same persons performing the, Work':;Any changes`to this list must be approved the :ity of La Quinta Department of Building & Safety adaj to work being perfot med by a changed sub- :ontractor. Failure to comply will result in a stoppage of work" and/ot the voidance of building permit. CkTY _. SUB -CONTRACTOR'S T}(p� p STATE WORKER'S BUS11tiIESS TRADE NAME LICENSE CONTRAC TOit'S COMP NAMEf LICENSE LICENSE .........: .... NUMBER OR F% NUMI3EAl NUMBER>::>::::;:::>::>::;:....::::::..::<:;;:.>:::::::>::::::::>:>;::::.::>.:: ;:.:::.:> ...:. EICP :17►AT.E A/C -1 2 EXCAVATE: I,tR(, CK C(,�7�t P _ - C 3d� 134 PIPELINES . C-34 C-8 ;:FOU.NQQT..... ASPHALT ..... A FRAMING B STRU.GTUI! AL; .: C-29 PLUMBING::.::>':-:.;:.::: C-36 DR. YWALL `. C-9 PLASTERING C-36 < :HVAC:::..:: ' ` >;:>:':» C-20 ELECTRICAL Rv�sr=��� C-10 53oo8(p 5rATC Fv 1JD 2961 8 r 1270 o tGer�erall...:.....:...:: 5 E ROOFING ` ,. _:.... .....:..... C-39 `:SHEET. METAL;: >:' C-43 FLOORINt�i C-15 f GLASSt C-17 :INSULATION:.;::'::.;; C-2 SEWAGE: DISP .:::.. C-42 PAINTING? C-33 :DECORATING::::::: TILE:; ;:.::....: ;: `':' C-54 GABINETSI>, . : ` ' :. C-6 INSTALLATION.... FENCING C-13 LANDSCAPING C-27 POOLS C-53 OTHER.