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9801-078 (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 a,nd Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 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: 1, 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. 70�4, Business & Professionals 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 4sued. My workers' compensation insurance carrier & policy no. are: Cartier Policy No. A2007 4370 (it, 9r6 (This section need not becompleted ifthe permit valuation isfor $1ommor less). ()|certify that mthe performance of the work for which this permit ioissued, | axaU not employ person in any manner so as to become subject mthe workers' compensation laws ofCalifornia, d agree that i,| should become sdbject to the workers' compensation provisions of Section 3700 of the Labor vwon`ing: Failure msecure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines upto $100,000,* in addition mthe cost mcompensation, damages ooprovided for inSection o7os o/the Labor Code, interest and attorney's fees. IMPORTANT Application iohereby made mthe Director mBuilding and Safety for a permit subject to the conditions and restrictions osx forth on his application. 1.Each person upon whose behalf this application iumade aeach person ox ' whose request and for whose benefit work ioperform �dunder o,pu�uumm any permit issued oaamau|t��tmoapp|inamn agrees to, &uhan. indemnity & hold harmless the City of La Quima, its officers, agents and omp|vy000. 3.Any permit ioouog aaoresult orthis application becomes nun and void if work is not commenced within 180 days from date o/ issuance of such ponnit, or cessation ofwork for 180 uoyo will subject permit to cancellation. | certify that | have read this oppodatiunand state that the above information is correct. | agree mcomply with an City, and Stam |owo relating mthe building cop�ruction, and hereby authorize representativesof this City menter upon the' above-mentioned property fo�ofr;spection purposes. Jamnoxune (Owner/Agent) Date, —`---ft �--_— BUILDING PERMIT. DATE VALUATION LOT. TRACT 6 71 OB S ITE __7P OWNER CONTRACTOR / DESIGNER ENGINEER USE OF PE RMIT its poa� PLAIN. 0HE 0F Y.01.3 11181SVANCT�- ow -fi ED JAN 2 3 1998 ItRACT C0114STRWIMOR 1,210,00 SF INTY OR11M.111 PEE 23 GRADING3 FEE 101 -OW -42 -W) TOTAL PERMI'VEAPS DUE NOW $2.695.90 RECEIPT 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 _ �9b'i1A Exhaust Fans O.K. to Wrap F.A.U. Framing jp��� �f Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath p Dryqall - In Lath Final Final lG £t 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 APPF� VALS Gas Test Waste Lines �rf�/f�� / Electric Final Heater Final Water PipingPlumbing rE Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster . Sewer Lateral & Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test zo 2 �— Appliances Final COMMENTS: Final Utility Notice (Gas) _ y 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 t Final Utility Notice (Perm) �: ~S. r�,. Vit.;, >>a +��'�;;�z:��9 "l ��_ .:� S : ,V �... .1 i t _, � , M'��� ~i ! i• sys.� '. ..k .v S , r,. !:. ;� ' �:;•,r: .+.: ;,�- ; � 2 1' j ..�: �. '`i,�- f^�;' ��. l b�,' � �:. .y :�. ['`� ',(!ir• r+�t. r•` � �, 'ft4��, 4 :(3'''�I� f+l� ,1/r+un/rreuu'rvl lir: GREENSTONEN'" A LOUISIANA. PACIFIC COMPANY NO'Il?: This cuvc';.g' chart onnpcnnale.. lim .willing and is fill, esti :ging pure -e, e,nle. Simcd li,alue i, prodded by insl:lllinl; the required number : 1 L:ip, I'vr 10(x) wI. li. m a mininnn I in'failed ILirknrss. InslAhlinn of the revpiirnl nook•, of LAI);, ma. eichl mnn• than the sIxvil'uvl mini unnn Ihickne-:uxI minnIt I vveiAht per sq, h. Actual m, nape will b,- inllurncc I h)• InL rnnditinns :unl .gq,liraiiun Irrbui:lur., :n,d may vary as unich .i.. LPA.•: ., iihnul .itpuhcant lc affect iny; die skied R-v:duc. haihuv. 1 i the installer II. pr-idc at Icasl the required number ,,I t+.ig; por 10110 sq. ft. anti :n lea.m the nrininwm il,Wkncx.. ratty wsull in a InPvcr in>Ialbd It -I .duo. I;nuq+.irt i. a, mac Them -during inslallatinna ol.rcr HW. Icquhinp marc Ih:m the sl:ncd number nl' I':.g' 1" ,Main the minimum installed thick nc..>. GreenStone and Cocoon are trademarks of GreenStone, a Louisiana-Pacific company. © 1997 GreenStone Industries, Inc. All rights reserved. Printed in USA. RV 30M 8/97. Sidewalls (presSurC filled-donsily 2.0 PPCF) `'x'4r +�"'...�. �f ' St r i 44S ;f '4. 7r,,+,.r►tt L,tj�1-r� !{'?.1,a) ' �y{,!� }.• lt•- r - 1 • • ; ,. t,,i� J• I+it `• .r�'�f.I � 1 �+, i74k �,;.�•1. •t. K:% ri .� h C(x cx�n SUIN /Cd lnsulalio ll ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART R-Valueat 19.4 Net Coverage No Adjustment for Trusses 56.7 75"F Mean Minimum 5.5 Gros Coverage Based un Mav,u n Net .917 Milan l wc. qhl Temperature thickness 2' 6' Trusses on TG' Centers Coverage Per Square Fool Installed lire Weight Per l"Ohl an Insulation Sgnaie Feet Mmmnmi Han;; Squarr. font nl Installed Squmr. Pgcl B1Pe Il1,000 I'qi 1,000 Inwl;ltroil Should Not Be Berl Pm Ned Rrxislance IRI of: Les% Than; I ci Bag 1. 000 Squat, fact Insulahon Per Bag Squaie Feel pnehr_a) Shnutf Not Be I ess Than, (11's) R-50 13.5 2.0.5 48.8 1.464 21.3 46.9 R-42 11.4 24.4 41.0 1.230 25.6 39.1 R-40 10.8 25.6 39.0 1.171 26.9 37.2 R-38 10.3 27.0 37.1 1.113 28.4 35.2 R-32 8.6 32.0 31.2 .937 34.0 29,4 R-30 8.1 34.2 29.3 .878 36.5 27.4 R-24 6.5 42.7 23.4 .703 46.4 21.6 R-22 5.9 46.6 21.5 .644 51.0 19.6 R-19 5.1 53.9 18.5 .556 59.5 16.8 R-13 3.5 78.8 12.7 .381 87.0 11.5 R-11 3.0 93.1 10.7 .322 102.8 9.7 8-97-TT/G-A R-13 (2 x 4) 3.5 51.4 19.4 .583 56.7 17.6 R-20 (2 x 6) 5.5 32.7 30.6 .917 36.1 27.7 7i Desert Sands Unified School District Notice: 82-879 Highway 111 01 922 Document Cannot Be Duplicated 619-77Indio, C5-3500 AA 922 CERTIFICATE OF COMPLIANCE Date 1/22/98 No. 16536 Owner NameCoachella Valley Housing Coalition No. 51-390 Street Ave. Carranza City La Quinta Tract # Lot # Type of Development Single Family Residence Comments APN # 773-082-007 Jurisdiction La Quinta Permit # zip 92253 Square Footage Log # Study Area 1210 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 1,210 1 or $ 2,226.40 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 Cashier's Check/Bank of America Telephone, •' , , r - Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Ellen Patino Signature • � J � Payment Received ✓'- $2,226.40 Check No. 2006714695 40TICE: Pursuant of 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 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 ;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 •4 4 " P.O. BOX 1504 APPLICATION ONLY G ,L., 78-495 CALLE TAMPICO Address— �1 � . dA? . C_ IA(,-, }(.�'� LA QUINTA, CALIFORNIA 92253 Address � City Zip Tel. Contractor Address p State Lic. I City & Classif. Lic. ff Arch., Engr., Designer Address Tel. City IZip I State I Lic. q LICENSED CONTRACTOR'S DECLARATION 1 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 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a permit to construct, atter. Improve, demolish, or repair any structure, prior to *Its issuance also requires the applicant for such permit to rile 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 the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1-; 1, 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, Buisness 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. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ( 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) i l I am exempt under Sec. B. & P.C. for this reason Date Owner /-4 - WORKERS' 4 -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. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM 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 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 Owner , i:, NOTICE TO APPLICANT: It, after 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. fSec. 3097, 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 state 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 above- mentioned property for inspection purposes. Signature of a0plicant —Date— Mailing ateMailing Address City, State, Zip .DING: TYPE'CONST. /Y OCC. GRP. Number 77.3 - r) 2 " int) ,I Description /! L.nT 03 134k (n-7 1 tial i Ict Description Sq. Ft. Size New ❑ No. No. Dw. G/ Stories f Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ itlmated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 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 INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION ATTORNEY - IN - FACT _AGREEMENT I/We hereby appoint COACHELLA VALLEY HOUSING COALITION, and/or any of its .authorized agents as my/our attorney-in-fact for the purpose of executing any notices of completion, waiver, of liens and/or executing contracts with subcontractors, and/or release of liens and/or handling building permits relating to that certain real property described below. All that certain land located and being in the County of Riverside, State of California, described as follows: LOT 18 BLOCK 67 OF UNIT 6 OF SANTA CARMELITA AT VALLE LA QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 67 OF MAPS, RIVERSIDE COUNTY RECORDS. Date Angel Trejo Date