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9801-072 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Fes— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N W -Professionals Code, and my License is in full force and effect. O M License # Lic. Class Exp: Date r d �, i f.i� i?I3i/, LILI oZ fD t�e�.�=, Signature of Contractor ZO O J U C=) 's OWNER -BUILDER DECLARATION W WW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for the following reason: Z ( 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). ( ) I, 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. f this reason g� -l� O C\1 %Date Si nature of Owner � Y J d Q VIrORKER'S COMPENSATION DECLARATION o tr I hereby affirm under penalty of perjury one of the following declarations: LO O ( ) I have and will maintain a certificate of consent to self -insure for workers' X W L= compensation, as provided for by Section 3700 of the Labor.Code, for the O � Q performance of the work'for which this permit is issued. C0 Q U, ( ) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this tl t— permit is issued. My workers' compensation insurance carrier & policy no. are: ,It Z Carrier Policy No. " ' •1', 1s 1,'+ti Y,./ij ZrY i" Y .20n0(�7 4 lYp fl: l..h a;��..i�. �ev�al,�,Sl�b%, t3! . 5a4V;)� y��•r'�fNs rt! J ` (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 California, and agree that if I should become 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: - pplicant LJ%G Warning: Failufe 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. r 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 i spection purposes. ,IS (Owner/Agent) % Date - 7 CONTROL# PERMIT�t1� BUILDING PERMIT DATE VALUATION S7'7.3O1! Z0 LOT TRACT IW {3111 + �i Lt JOB , .71 -`o-39 �'.1�iJUM Ct1 RMANF' A APN 773-01-010 ADDRESS ��� OWNER CONTRACTOR / DESIGNER / ENGINEER pqq ( r�q� ry 10,8,!. N1A RTIW.;7i { y+ (� t { :7V 5tii�i'..�5 � aYil �..0 .ri `111 i lfl C [1r POBOX 31.136 45701 MONR0F 1" S 1'1; Q VAUM 04"SU'RT CA, 9226:1 iND10 CA l7i�#?}7ri7-i1 s7 MTN USE OF PERMIT A S f -1; (�tb31`.0 iJi2i S NCS i I -NC ;AY WAM a (ail Poen'.. ,81,a:ra:.k i{ JA I X Ip(�p ry998 f J S�i.tiR. f..�5}�Ir:~13 i .�Jl�.l llfil� 1,2.I01;i11}'317 INaRC14119 AT 10 SFC, -e' ' FI. �` • �At�ACs`#:.i�yA.CtC�t�k'3` 5�5.ti0 l� �+ fes,\� a�9] e n t. 14 yy1�y f ♦}qy� y* y g PERM IT VC41 SUMMA i0l' 'c0NS11iCfi,'('.i0N, irm, 101.011 1-418-t'}t) gIS14et•1+t III Ala ('H r F� 1()1_»(}f1(1-4,14- 'tT1 :1 r s� _.. 1it,Wf,R1tiA11 FEE. 101-000 4�0-()tiff 171. 07 PLUMB INO "1's 10.1.-000-414"04) S 1121.50 4?'i {>1 Ct d� `j`l�1�d Ftl� - 6a risT )t�T-fi(i(i- �T (a S7. ? G-RAT)INC't f ,L"E 101 -OW -423-000 1.l(J IN RASS..f`3:UCT(JAF,' RiE 22:5-000.443-342 f�pml- AN 1.01-000-441-345 �MSot S_UB,,trf rpt, 1`ROC,"l'il N AND flf,.Ak ('31F.CK x%0371)4 S) PRE -PMD FEES. $0,00 RECEIPT DATE 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 9F' F.A.U. _ Framing D Q2 9i? Compressor Insulatio5apl&Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Q s D II - Int. Lath Final Final 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 APPROVAL Gas Test Electric Final Waste Lines ,{0 / 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 -12-- 1F. 7— Appliances Appliances Final Final Utility Notice (Gas) �G 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) =L COMMENTS: Address /_ 7c N (211, '�-�-r4 -k d ;'�'�,A .=.A �,t�'` ?'�C.. ,.^��,, ,.��w�..:. •. �'.� J'�..'ir4. 1fi7E 'rr. r `w••..'�. 44". • P.O. BOX 1504 APPLICATION ONLY ,p 78-495 CALLE TAMPICO FKijIJZ%� LA QUINTA, CALIFORNIA 92253 Owner. Mailing / Address pyoX f0' - 4 - Contractor Address " p & Classif. I Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # 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 effecI. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a permit to construct, after, 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 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). I,' 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, 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.) I l 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 contractor(s) licensed pursuant to the Contractor's License Law.) 17 1 am exempt under Sec. B. & P.C. for this reason Date Owner�'�^- ��d�•'�-�- ��� 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 CO Policy No. Company r.7 Copy is filed with the city. O 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.m Date Owner%''• NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should becorne 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. (Sec. 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. 1 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 BUILDING: TYPE'CONST. / OCC. GRP. A.P. Number %, 3 —Q51 " 010 Legal Description "�! L -0T G VH %8 . U N t'f Project Description Sq. Ft. ,+ No. No. Dw. Size / ✓ Stories Units New ❑ Add ❑ Alter ❑ Repair O" Demolition ❑ stimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure ti TOTAL REMARKS ' ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line a 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 THIS ATTIC HAS BEEN INSULATED TO: This attic has been insulated to the it -value indicated above, With Cocooll'", the high -efficiency insolation. Madc from a minimum of'WIG, recycled materials, Cocoon is scientifically formulatc(l to cicli%,cr greater cillicicoicy per inch than other insulation materials. RNAUC is :1 111CMUrc of'rcsistance to heat llow — the higher the It -value, the grcalcr the insulating lio%vcr. 11' you would like to add more insolation to your home, contact your Cocoon authorized dealer. I` alnngj,rr u,,.•,I lt,.. GREENSTONEE',"" A tOUISIRNA-PACIFIC COMPANY NOTE: This "oel'.'Jze rh.m "onlrnVlc. Inr -III g :mJ i, It,, emintnin); I,u pow, Hole. tibnoJ It -,.due i. prrn'ided he inelalloig the Iaplircd iilwr .d h.l);. Ix•r I(xx) mi. ti. .n a mininmm in>I.JIrJ illuk.w- InUalimiun of the nrpli"'I nundr, nl h.l);. nl." ,iclJ marc rh:u, Ihc>Ixcil ill[ minimum dm knc.1.11 Ill lotion uurin, ,.rich) I.cr ,vq. It. AcrtI.J ern crel!o "Ill Ill- intlucnu•J hp 1.4h "ooliloo'% ...IJ .q qdi. .Imm Ir. hnvplr., .nnl roe)' ,.np a. mush .I. IIP'., 'oleo l .ylnil it .ullh :d Peeling the o-ul"I R-c.duc F.ulun•..I the in.lellc, III Prn,ndc n Ica>I rhe Irq uncJ nuu,ht.. .d hl);. Ilrl 1000"I. II. and :II h. -I file I lll11111111,1 I IIo"'%' I c..uh in .I Irn,rr unLdlrJ It ,.due 1 ,nnl.e. Inn, ul.n .lccur alurin); in.IalLm o" ..h„,v R {II. "-'I.ming none Ihan the gawd nuu Iter .II h.l);. I„ ,.M.nn Ihr m inin,unl in..lallvd Ihickn- GreenStone and Cocoon are trademarks of GreenStone, a Louisiana-Pacific company. n 1997 GreenStone Industries, Inc. All rights reserved. Printed in USA. RV 30M 8/91. 8 -97 -7/G -A ' tii}�. ��. , r t • t .'i C000011 SlahiliZiUd IIISU1,111 11 30 Ih. hag ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART R-Velur. al 19.4 Net Covetage No Adluslnlenl lot Imsces 56.7 76"F Idran Mm In 5.5 f Ins Cnvr,ag^ Ilasrd on K".m Net .917 1 Mnnlot Wrmlu lenq/elalu,r Thickness 2 r G' lmaers oo 16 Cenlets Cme,age Pe, Sgoarr, Iroo Installed the Munn PCI In Ohlam ao Insol"hoo MNnunml It.ln: Sgoan• l INH of Odq� Orqmrd Insulahml Should No Be. Sl Incl Bell cd I',, InsInlL d Sgn.nr I ect 1'e, Latin Be,isMnce lar of That Leas Ihan Per Per Ban I,(Nq Square f eel In:ul.wnn I'ct Bag Strome )rel (ss Shmihl N II 0C I c•,s Ihan Ilh•.1 1.464 21.3 46.9 R-50 13.5 20.5 48.8 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 11-32 86 320 31.2 .937 34.0 29.4 R-30 8.1 34.2 29.3 .878 36.5 21.4 R-24 6.5 42.1 23.4 .703 46.4 21.6 R-22 5.9 46.6 2.1.5 .644 51.0 19.6 R-19 51 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 Side-walls (pressure filled -density 2.0 PPCF) 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 1 36.1 27.7 -- ^y�R agvF.t..;tcac Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201619-775-3500 CERTIFICATE OF COMPLIANCE Date 1/22/98 No. 16531 APN # 773-081-010 Jurisdiction La Quinta Owner NameCoachella Valley Housing Coalition Permit # No. 51-435 Street Ave. Carranza Log # City La Quinta Tract # Lot # Type of Development Single Family Residence Comments zip 92253 Square Footage 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 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 Cashiers Check/Bank of America Tehphone Name on the check By Dr. Doris Wilson Superintendent y Fee collected /exempted by Ellen Patino Payment Received $,2,,2.26.4Q'- Check 2;2?E.4Q'Check No. 2006714095 Signature L 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 allect 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 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-foflows: LOT 6 BLOCK 68 OF UNIT 6 OF SANTA CARMELITA AT VALLE LA QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 63 OF MAPS, RIVERSIDE.COUNTY RECORDS. .\ZIAS "OQM� Date Juan Jose Martinez Date Maria Gutierrez Martinez