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
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J S�i.tiR. f..�5}�Ir:~13 i .�Jl�.l llfil� 1,2.I01;i11}'317
INaRC14119 AT 10 SFC, -e' ' FI.
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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