SFD (11410)No.
P.O. BOX 1504
11.141.0
Builing ••7&105 CALLE ESTADO
Address 52-355 Nava. rO . 1 LA QUINTA, CALIFORNIA 92253
Owner r
Coachella Sly douse Coalit on
" BUILDING: TYPE CONST. � OCC:. GRP.
Mailing
Address A5701 .°G Monroe St A.P. Number 773-274•'-016
City Indio Zip92201 T347-3157 Legal Description Lot' 5 ..BIOCLi 102
Contractor
Owrier/ilde Project Description �^'D
V,
Address ,
✓tip ° f
City Zip Tel.:.
State Lic. City
& Classif. Lic. # Sq. Ft-1222 No-. No. Dw.
'
Size Stories. Units
-..Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑'' Repair ❑ Demolition;❑
Address Tel. Permit does not :include block walls -
City Zip State _ or pool ,
Lic. # j
j LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is In full force and,
-
effect ;
_SIGNATURE DATE ,• .., Y• ,ia
OWNER-BUILDER DECLARATION Estimated _Valuation }
I hereby affirm that I am exempt from the Contractor's License Law for the following �� 5(�� ��
reason: (Sec.. 7031.5,Business and Professions Code: Any city or county which requires a'' p
permit to construct, alter, improve, demolish, or repair any structure, prior to 'its issuance also
• requires the applicant for such permit to file a signed' statement that he is licensed,pu`rsuant to. PERMIT AMOUNT
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 the basis
,for the alleged exemption. Any violation of Section 7031.5 by''any applicant for.a permit Plan.Chk.Dep. _
. -
'subjects the applicant to a civil penalty of not more than Ove hundred dollars,($500). - � � • V
❑ 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. J:i •
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, "�'•'"'�' V~
provided that ME!Ch. such improvements are not.intended or offered for sale. If, however, the building L • _
+rte• - i
or improvement is sold within one yeai'of completion, the owner-builder. willhave the burden 'Electrical - - +11 ro • .1.)-•1
of proving that he did notbuild or improve for the.purpose of sale.) _ • - - - -
I, as owner of thelproperty, am exclusively contracting with licensed contractors to con- Plumbing
struct the•.project (Sec. ° 7044, -Business and Professions Code: The Contractor's License. Law _
does notapply� to"•an. owner of property who builds or improves thereon, and'who contracts for- S.M.I. + . L• +' ... -
such projects, with a contractor(s) licensed pursuant to the Contractor's License Law.) r -
• Grading :U. UU
0.1 am exempt under Sec: B. & P.C. for this reason
Driveway Enc. • roti
`it3 Z.0-1
Date l f�=''•�-'>owher �t �=%t� �:_'r-_-- ,%rte',-�.;.,✓_..••�. Infrastructure '
VU
WORKERS' COMPENSATIONDECLARATION
" I hereby affirm that'l 'have a certificate of consent to self-insure, or a certificate of r
Worker's Compensation Insurance; or a certified copy thereof. (Sec. 3800, Labor Code.) hK
" Policyr�No. .Cornpany o T
I]�Copy.is filed with the city. . ❑ Certified copy.is hereby furnished. 7
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE s
(This section neednot be completed ff the permit. is for one hundred dollars ($100) valuation ti _
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.
Date___L_Owner-
NOTICE
wnerNOTICE TO APPLICANT: If, after making this Certificate
om
of Exemption you should bece ZONE:"'�`- BY: •
subject to, the 'Workers' Compensation provisions of. the - Labor Code, you must forthwith , -
comply with such provisions orthis permit shall. be deemed revoked. ' Minimum Setback`Dlstances: ' • ' `
Front Setback from Center, Line
Rear,Setback from Rear Prop. Line
• CONSTRUCTION LENDING AGENCY Side Street Setback from Center 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 Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is-subject to' FINAL DATE INSPECTOR
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. _ Issued by: Date—.Permit
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 above-. -
mentioned property for inspection purposes. Validated by:
Signature of applicant - Date
Mallin
9 Addressa Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CAR P. I S0. FT.
WALL SO. FT. ®
SO FT @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYEIa
GAS (ROUGH) i0 , 0
�TEMP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
FINAL INSP. 3(� 2 2
• a
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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 &P
GROUND PLUMBING �14
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEtoy
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER 4Q SEEUQ 1A K ,/r
3�[
OUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) i0 , 0
�TEMP.
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. 3(� 2 2
• a
FRAMING 83-13 /Kd-
FINAL INSP.
ROOFING/ _ a� 2�q�(�
LY J
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWAL
LATHING —3
MESH
INSULATION/SOUND �13
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (Al Q1 347-8631
La Quinta
Permit #
Log
Date1/7/93
No. 11952
Owner Name Coachella Valley Housing Coalition
No. SEE Street BELOW
Type of Permit
City La Quinta . Zip 92253 Study Area 112
APN # Tract # Lot # 0 Square Footage 112,736
Type of DevelopmentSingle Family Residence No. of units 10
Comments 52070 Madero; 52155.355 Navarro; 52447 Rubio; 52250 Obregon; 52865 Velasco
(6 Ccs 1222s,
52d5dMpndn7a;?A91; ASn Riihi . C;?I;nO MartinP7 (4 Cad 1IS1 cf)
Af 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 1.58 x 12 736 or $ 20,122.88 have been paid to D.S.U.S.D. for
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 City of La Quinta Telephone. 564-2246
Name on the check
By James E. Livply
Assistant Superintendent, Business Services
Fee collected /exe ed by rthur
Payment Received r ,
Signature 1 Check "No. 7.4�44
Collector. Alfaich a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Recei�t Copy - Accounting
L
• VETERANS ADMINISTRATION, U.S.D.A. FARMERS HOME ADMINISTRATION, AND
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Form Approved
HOUSING FEDERAL HOUSING COMMISSIONER OMB No. 2602-0192 (Exp. 11130/831
For dccuralc register of carbon copies, form may be separated along above
fold. Staple completed ehcels togetlter In original order.
0 Proposed Construction DESCRIPTION OF MATERIALS No.
❑ Under Construction
Property address
Various
(Tu be Inserted by HUD. VA or Fm11,11
City La Quinta, State CA. 92253
Mortgagor or Sponsor Directors Mortgage Loan Corp. P.O. Box 1489 Riverside,CA. 92502
(Yahtc) 1 Addre►s)
Contractor or Builder Coachella Valley Housing Coalition Plaza I, 45-701 Monroe St.Suite G
(Nanw) Indio, Cit. 922(9'it'dleu)
INSTRUCTIONS
1. For additional Information on how this form Is to be submitted, number required, then the minimum acceptable will be assumed. Work exceeding
Of Copies, etc„ ase the Instructlons applicable to the HUD Application for minimum requirements cannot be considered unless specifically do"fibed.
Murtgage Insurance, VA Request for Determination of neasonable Value, or A. Include no alternates, "or equal" phrases, or contradictory Items.
FmHA Property Information and Appraisal Report, as the :V be. IConslderetlon of a request for acceptance of substitute materiels or equip -
2. Describe all materiels and equipment to be used, whether or not sho
case mn wment Is not thereby precluded.)
on the -drawings, by marking an X in each appropriate chock -box and entering 5. Include signatures required at the and of this form.
the Information called for each space. If space Is Inadequate, enter "Sae mist." 6. The construction shell be completed In compliance with the related
and describe under item 27 or on an attached sheet. THE USE OF PAINT drawings and specifications, as amended during processing. The specifications
CONTAINING MORE THAN THE PERCENTAGE OF LEAD BY WEIGHT Include this Description of Materiels and the appllcabl• Minimum Prpperty
PERMITTED BY LAW 19 PROHIBITED. Standards.
3. Work not specifically described or shown will nut be considered unless
1. EXCAVATION:
Bearing soil, type Per soil report- - Sandy Loam
2. FOUNDATIONSt
Footings: concrete mix 5 Sack ; strength psi 2000 Reinforcing 2 #4 Bars
Foundation wall: material Concrete Reinforcing _
Interior foundation wall: material Party foundation wall
Columns: material and sizes Piers: material and reinforcing
Girders: material and sizes Sills: material
Basement entrance areaway Window areaways
Waterproofing Footing drains
Termite Protection __-Soil Poison by chemical spray With cert
Basementless space: ground cover ; insulation foundation vents
—
Special foundations Rebar tie at Qarape door opening all concrete shall have compressive sL - ngth
Additional information: OF 2000 lb. in 28 days.
3. CHIMNEYS:
Material Galt/. Dbl. Wall Prefabricated (make and jqt) Amiyellt 4"
Flue lining' material Ileaser nue size 3
Fireplace nue site
Vents (malaria/ and sict): gas or oil heated ; water healer -- -3
Additional information: � a lv . 4
4. FIREPLACK
Type: ❑ solid fuel; ❑ gas -burning; ❑ circulator (make and rt;f) Ash dump and cleanout
Fireplace: facing lining ; hearth ; mantel
Additional information:
5. EXTERIOR WALLS:
Wood frame: wood grade, and species D•F. #2 [N Corner bracing. Building paper or felt #15 Felt
Sheathing thickness width ; ❑ solid; ❑ spaced " o, e.; ❑ diagonal;
Siding grade ; type ; site exposure "; fastening
Shingles grade 7 /c� ; type ; size exposure "; fastening
7�B M / Pa
Stucco 3 coats ; thickness Lath Mesh Wire er._Rarkg It..
weight
Masonry veneer Sills Lintcls Base flashing
Masonry: ❑ solid C]faced ❑ stuccoed; total wall thickness _ _._ "; facing thickness "; facing material
Backup material thickness "; bonding
Door sills Window sills Lintels Base flashing
Interior surfaces: dampproofing, coats of furring
Additional information:
Exterior painting: material LXt• Latex number of coots.
Gable wall construction: M same as main walls; ❑ other construction
6. FLOOR FRAMJNG:
Joists: wood, grade, and species ; other ;,bridging ; anchors
Concrete slab: 0 basement fluor; ❑ first floor; 0 ground supported; ❑ self-supporting; mix 5 Sack ; thieknas 4 _r';
reinforcing - 6/6 khre Mesh ; insulation ; membrane 10 Mi,I Poly
Fill under slab: 'material Sand thickness 2" . Additional information:
7. SUBFLOORINGI (Describe underflooring (or special floors under itom T 1.)
Material: grade and species ; size ; type
Laid: ❑ first floor; ❑ second floor; ❑ attic sq. f1.; ❑ diagonal; ❑ right angles. Additional information:
D. FINISH FLOORING: (Wood only. Describe other finish flooring under item 21.)
Locwritm I Rooms I Gatti I Srtctu I7r1ucxNusl Wiont I BLM;. Psrsa I FINItII
First floor
Second floor
Attic floor s.l. ft.
Additional information:
Previous edition may be used until supply is exhausted I DESCRIPTION OF MATERIALS
HUD -22005 I6-791
DESCRIPTION OF MATERIALS
9.
PARTITION FRAMING:
Studs: wood, grade, and species D • F •2
size and spacing 211 X 411 16"0 . C Other
Additional information:
; sash thickness7
10.
CEILING FRAMING:
weights; ❑ balances, tyle head flashing Alum
,Joists: wood, grade, and species Trusses
Other Bridging
Additional Information:
'
11,
ROOF FRAMINGt
material ;screens, number ;Storm sails, number
Rafters: wood, grade, and species Trusses
Roof trusses (sec detail): grade and species D. F.
Additional information: See atL-achet:l
detail.
12.
ROOFING:
She•thi wood, rade, and cies 2t1 CD
ng'
Colic
x Ply or 7/1611 Wafer Board
; IN solid; ❑ spared—" o.c.
Roofing -Tile
grade size 1.3 X16 ; type
Underlay Felt
weight or thickness 30# size ; fastening Nail
Built?up roofing
Flashing: material Galva Metal
number of plies surfacing material
26
_ ; gage or weight ❑ gravel stops; C] snow guards
Additional information; Overhang 1" CC x Plv Sheeting
13.
GUTTERS AND DOWNSPOUTS:
Shutters: ❑ hinged; ❑ fixed. Railings
, Attic louvers
Gutters: material
gage or weight size shape
faint : number coats
Downspouts: material
gage or weight size shape ; number
-Dual nanp
Downspouts connected to: ❑ Storm sewer; ❑
sanitary sewer; ❑ dry -well. ❑ Splash blocks: material and size
Additional information:
Kitchen cabinets, wall units: material Q-qk
14.
LATH AND PLASTER
Base units: material _l7alc
__ ; counter top _ 131 a h i r ;'edging -Pl ns t i C
Lath ❑ walls, ❑ ceilings: material
weight or thickness f lasier: coats finish
Finish of cabinets VIarni eh ; number coats 2
Dr wall walls, G
Y• (� ❑ceilings: material
T—
Brd . •thickness 2 ;finish Text
—G
: model S I-rl1491
Joint treatment Taipei Firewalls
- 5 8 -VD Board - Natural Tape
IS.
DECORATING: (Paint, wallpaper, etc.)
Additional information:
Roo.0
Kitchen Lal
Bath IZI
Other Dinnin hat
Liv Bdrms Lat
Additional information: _
WALL FINISH hIATLRIAL ANU APPLICArto•1
2
is
CRILIPID FINISH MATERIAL AND APPLICATION
ame
16. INTERIOR DOORS AND TRIM:
Doors: type Hollow Core
material Masonite thickness 1 3/8"
Door trim: type S) l m1 l ere ;material -Wood Bate; ,)Pe ne ; material Wood 3r-
1
Finish: doors i Latex Enamel 2 C oa s ; trim ,size 2
Other trim (lent, Opt and fvralton) ---
Additional information.
17.
WINDOWS:
Windows: t �l i rli no make _ Phi
�
l i ere / 1"
:material A11 Int $
Glass: D -SSB
; sash thickness7
gradeSB ; ❑ sash
weights; ❑ balances, tyle head flashing Alum
Trim: type material
Wralhrrstripping: type S trippinp,
Paint ; number coats
Felt
Screens: ❑ full; ❑ half; type Alum
material Storm sash, number
; numberep r Plan,creen cloth material Saran
Basement windows: tbpe
material ;screens, number ;Storm sails, number
Special nindows
Additional information:
18.
ENTRANCES AND EXTERIOR DETAIL:
Main entrance door: material Me al
width .. 3611 1 thickness -1/4 toFrame: materialWOOd , thicknessLZ"
Other entrance doors: materialvs WOOCi
11 rr
width �_ ;thickness 1 J/ fit: Frame: material good _ ; Ihicknetsl-1411
Ilead flashing
Weatherstri in
PP g: type saddles
Screen doors: thickness "; number
; screen cloth material Sturm doors: thickness ", number
Combination storm and screen doors: thickness
_._"; number ; screen cloth material
Shutters: ❑ hinged; ❑ fixed. Railings
, Attic louvers
Exterior millwork: grade and spceics
faint : number coats
Additional information: __ S1 i rip a 1 t Im Door
-Dual nanp
19.
CABINETS AND INTERIOR DETAIL:
Kitchen cabinets, wall units: material Q-qk
; lineal feet of shelves P1 an ; shelf width 12„
Base units: material _l7alc
__ ; counter top _ 131 a h i r ;'edging -Pl ns t i C
Back and end splash _P1 aS t i r
Finish of cabinets VIarni eh ; number coats 2
Medicine cabinets: make __Grote
: model S I-rl1491
Other cabinets and built-in furniture
Additional information:
20,
STAIRS:
I TRecw
STAIR
RULRt
STaINUP
Material I Thickness I Material I Thickness I Material
Basement
Main
Attic
Disappearing: make anti model number
Additional information:
2
IIANURiIL B%Lt.s rtes
Site Matrrisl SiteI Material Site
21. SS•^�ECIA! NLOORS AND Y1Al14SC0T: Describe Carpet as listed in Certs ied 11ruduct5 Direct
I,ncmT,ON NIAIPMAL, CcLon, Qonnna, Suer, GAaa, Erc. TitaulwcD
MAnR1AL
I:i:ehc.l Vi_nll_
Vega ArmsLrono He La
Vena Arils L.rorl
01 -her i't 1-n ac PI -1i
l 1j1G9,Metal
U elane Carpel l1511.01a
0
U -CATION MATen1AL,'Cawa, :)Ona7e, CAP. Suers, CAGE, ETC. IlucnT
7
Doth I
(v AIA nAM UNDInrLOOa
MATaRIAL h9Arae1.%L
lond oucre e
1000 UreLhanQ PadZr t
Huonr Naraetr IN SNoevaas
Ovan TO (PAO?A FLOOR)
1=atlircoot acccsrori:a: ❑ Rcccsacd; mai:rial number ; [, Attached; material Chrome ; numb.; 4 ••_
Additicrml infcrmoticn:
22. FLUMMM
FIxTURIt
iNU1.IC�n
It
L.oCATIOt/
MAxt
No. Sltt CAM
MrR'r FIXTURt IoaNrIr ICATION >U
Additional information: -.qG
,
C] Space heater; ❑ floor furnace; ❑ wall heater. Input Wish.; output
Cx,I-i1,
'
LU5=J40 1
Lnvmcry
_2_
ial"I s
1.11L'ue.gaI_
Marble 20 x 17 AImnnd
Wctcr elect
; storage capacity
Ba I is
L.I_ , '
C i-100 :X444 I_
Bathtub
Make and model Control
_
Shower over tubo_.
Stall o!:ov+cry
2_
Electric heating system: type Input watt&; Q
�I.a�r-n
_
[nj11i
-�--
Ventilating equipment: attic fan, make and model
; capacity—•, cfn
kitchen exhaust fan, make and model Mange Fair Hood+2 six -ed
1 nundr; imys
�.
i
_
t
AM Curtain rod 46 C3 Door ❑ Showcr pan: material
Water supply: [a public; ❑ community system; ❑ individual (private) system.*
S.-wnge diopoar:l: (Apublic; ❑ community system; ❑ individual (private) system.*
{;Sha:& and dumb. individual e�,stem in complete detail to ssparote drawings and ipeclfications according to nrquucments.
flour. drain (inside): ❑ cast iron; ❑ tilt; ❑ other House (louse &ewer (outside); ❑ cast iron; ❑ tile; ❑ other�.-
bYatcr piping: ❑ galvanized steel; ❑ copprr tubing, ❑ other Sill cocks, number .
Domc-'sic %voter heater: type G19,s 1 ins cl•nraop ; make and model Me AM40 ; heating capacity—/ .,IpnI
gph. 100' rice. Storage tank: mnta1ia1Qh1SS/SLee1 ; capacity..(%,(_ gallons
Gr.3 ca•vicv; ja utility cempany; ❑ liq. pet, gas; ❑ other Gas piping: Q eaokiog; Q':;o%uc heating
Fcotin drains vanncxtcd to:
g ❑ sterna ocwer, [J eartit.:ry exwcr; ❑dry well. Sump pump; make end model
21 M-AUXSt
Q Hot wet. -r. ❑ Steam.
❑ Radiators.
R.✓diant panel
❑ Circulator.
; capacity ; discharges into
❑ Vapor. ❑ One -pipe system.
❑ Convectors. CJ Dazeboard radiation.
❑ hoer; ❑ wall; ❑ ceiling. Panel coil:
❑ Return pump. Make and model _
Eviler; make and model
Additicnal information:
❑ Two -pipe system.
Make and model _
Material
Output
capacity gpm
Dtult.; net rating Dtuh
Worm air: ❑ Gravity.`❑ Type of system ` _ Furnacc
. -.Forced.
Duct material: supply PlaSLle . , «I Inn 'alv McLa1 Insulation F'ih," Stbiekness 211 n O' +d: t►jr intake
Furn.cec: make and mu"Id Ll e . (J& UG -';j' o Input . O1000
Dluh.i output,a(lni)dt) �.. Dtuh
Additional information: -.qG
,
C] Space heater; ❑ floor furnace; ❑ wall heater. Input Wish.; output
Dtuh.; number una
Molle, model Additional information:
,.o....--
G;ntroh: make and tyles Jade 111 R Ate I-nma I- i r CI nrlC—ia-i Hi c!e,4,bar_-14
Additional information:
Fucl: I7 ODA; ❑ oil; Q gas; ❑ hq, pct. gas; Q electric; ❑ other
; storage capacity
Additional information:
Firing cquipment furnished separately: ❑ Gaa burner, conversion type. ❑ Stoker: hopper feed ❑; bin feed ❑
Oil burner: ❑ prcasurc atomizing; ❑ vaporizing
Make and model Control
Additional information: - -
Electric heating system: type Input watt&; Q
volts; output... Bttd
Additional information:
-�--
Ventilating equipment: attic fan, make and model
; capacity—•, cfn
kitchen exhaust fan, make and model Mange Fair Hood+2 six -ed
fan— H81555 .�-
-" 00mr 'acstip3, vcntibiting, or coolie oquipmcnt ,
24. MP-CIMC V91MM
Service: ❑ overhead; Q underground. Panel: ❑ fuse box; 1Wcircuit -breaker; matte Rrvant AMP'S ,a5 i eireuiuJj_
Wiring: ❑ conduit: ❑ armored cable; Q nonmetallic cable; ❑ knob and tube; ❑ other
Special outlets: ❑ range; Q water heater; ❑ other $(marl
Doorbell. ❑ Chimes. Push-button IocationsFlonL door Additional information:
25. UG1'I71HO FIXTUPM:
Total number of fixtures 16 Total allowance for fixtures, typical installation, i 400
Nontypical installation
Additiunal iafurmmiun:
nt=SrRlPT1nM 0[ MATERIAI
26. INSULATION: DESCRIPTION OF MATERIALS
VOCATION T" "RnLu MAnRLAL
Roof Trrt, AND Mtr..Uo „r INSTALLATION
VAPOR BARRJRR
'
Ceiling 11 – B t t S
Wall -rt R-13 Batts
Floor
27. MISCELLANEOUS: (Describe any main dwelling materials, equipment, or construction items not shown elsewhere; or use to provide
additional Information where the space provided was inodegvato. Always reference by item number to correspond to numbering
used on this form.)
HARDWAREt (make, material, and nnish.)
Kwi ks • B lair !-Lass
SPECIAL EQUIPMENT: (State material or make, model and quantity. Include only equipment and appliances which are accept-
able by local low, custom and applicable FHA standards. Do not include items which, by established custom, ore supplied by
occupant and removed when he vacates premises or chattles prohibited by low from becoming realty.)
disposal Badger 1
PORCHESI
TERRACES:
OARAON:
-SPP P1 an
HUD-9200516-70)
WALKS AND DRIVEWAYSt
Driveway -width 16 base matcrialConcrete 411
; thic�C�ess surlacing
31--�'
material
Front walk: width 3 m.teri.IConerete thickness 4 ",
; thickness
; Service walk: width material
Steps: material ; treads—";
; thickness
risers_N. Check walls
OTHER ONSITE IMPROVEMENTS:
(.SPf(07 @I "I"isr 0011111 IMP►IIVINrnt1 not dtlrrlbrd Ib(wherr, In(luding (tents Ju(A el unWuOi Ireding, dralnsit lhYNY/fl, /IrNNIRj
and arnJJsry Jtructurri.)
IuallJ, JrIN11, /e1llR�l,
6' Wood Fence
Pront yard automatic sprinklers ,
LANDSCAPING( PLANTING, AND FINISH GRADING:Per 4145.1,Rev 1, Appdix 8
Topsoil " thick: ❑ front yard. ❑ side yards- rear yard to feet bchlrul main building.
!.awns (ueiraf, ssddrd, or /Priurd): (j�front yard �'�7 ; ['s;� yards ; ❑ rear yard
Plant
Planting
as sprciArd and sho n ort drawings; ❑ as fullows:
Slade area, deciduous, " caliper. Evergreen trees, to
', B & 0:
Low flowering trees, deciduous, ' to Evergreen shrub, ' to
', B & B.
High -growing shrubs, deciduous, ' to Vinci, 2 -year
Medium -growing shrubs, deciduous, ' to '
Low growing shrubs, deciduous, ' to I
_
[oawnnaATtotv,—'Ibis exhibit shaU be identified by the signature of the builder, or sponsor, and/or the proposed known at the time of application, / P Posed mortgagor
if the latter is
Date �
Signature
Signature—
ignature
HUD•82006(8.791
VA Form 28.1862 Form FmH6 424.2
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Certificate'issued,pursuant tothe•requWpments_of Section 346fof tt e�Unifor 3Building .r
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Code certify�ng7, that of the time of issuance • this, structure;vas 'in �ompliohae w the various
ordinances of the City. regulating-, building construction or use 'For the, following.F
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