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9806-057 (SFD)z LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of f— 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 =) ch License # Lic. Class Exp. Date r` CY u7 ' W r- C:VHC° 1?i31198 oZ r— Date Signature of Contractor - 0 r� ontractorOr,� J U � OWNER -BUILDER DECLARATION LU LLj I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z(1() 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). ( e e'mpt nder Section B&P.0 tis reason O U') t ate b �''� ignature of Owner ��/''��._ rn d Q WORKER'S COMPENSATION DECLARATION o 2 Z I hereby affirm under penalty of perjury one of the following declarations: LO Cc Q () 1 have and will maintain a certificate of consent to self insure for workers' X W �= compensation, as provided for by Section 3700 of the Labor Code, for the Q J Q performance of the work for which this permit is issued. CD Q C) (t) I have and will maintain workers' compensation insurance, as required by Q U QSection 3700 of the Labor Code, for the performance of the work for which this li H permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier Policy No. ob Z) r- O TRUCK INSURANCE I A ;007 4370 00 fib 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 pr visions of Section 3700 of the Labor Cdde, I sall f rthwith comply with th e p vlsio S. 6 Zate:� Applicant— Warning: pplicant Warning: Failure 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 Pis 44 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,, indemnity & 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. 1 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 e construction, and hereby authorize representatives of this City to enter upon the4bove-mentioned property for in pe�ctio,n purposes. YSignature (Owner/Agent) 2 �6 Date g PERMIT # �"CONTROL # BUILDI PERMIT =, DATE VALUATION LOT 9$062157 TRACT f;4-: *,.� % 1 d $76,898.40 2tt JOB SITE APN ADDRESS 51-510 AVENIDA CARRANZA 773-1254101 OWNER CONTRACTOR / DESIGNER / ENGINEER GILDA IMELDA MUL1,1INS 01,NNER / BUILDER WITH CVHC INDICT CA 92201 (760)347-33.57 C BL# USE OF PERMIT P�� SFT) (C 121508) - ERMI T DGF.S NOT INCLUDE BLOCK WALLS OR POOL. PLAN CHECK. PORTION OF .FEES R.F: ucED FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE. TRACT C;ONS'TR[fC {'ICN 1,215.00 SF PORCR/PATIO '23.00 SF DARA00CARPORT 455000 5F 3 FT. WOOD FENCE 200.00 LF EV111WA'1'ED COST OF CONSTRUCTION 7bi8!�>at.41; PERM -17 FEE SUN -IN A IV CONSTRUCTION FEE 101-000-418-000 $535.00 PLAN CHECK FEE 101-000-439-318 x,115.82 MECHANICAL FEE '101.-000-421-000 $53.50 IELECYRTCAL FF -h 101-000-420400 $121.13 PLUMBING FW. 101.000-41.19-000 b1 s.5t1 STRONG IVO'TCON FEE - RES'ID 101-000-241-000 GRADING FEE 101-000-423-000 $240,00 (WRAIrrRUCTURE FEE 225-000-443.312 SL695.08 PRECISE, PLAN �t + IQ 1 -000-441445 � $25A0 s 11 SUB -TOTAL CONSTRUCTION AND PLAN CHECK JUN 18 $'2,709.72 -1998 1,ESS. PRE -PAID FEES 40.00 TOTAL PBRIMT 3+xEs. DUE NO1V $2,709.72 RECEQpT DATE BY' DATE FINALED INSPECTOR . f' INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 1AC1_ Underground Ducts Forms & Footings Ducts Slab Grade Fly Return Air Steel _ Combustion Air Roof Deck - _ Exhaust Fans O.K to Wrap - 2-7— 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 , -7—W D?/wall - Int. Lath - Q Final `Z -S T Final L POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover 5tl 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 Lateral3��� Pool Cover Sewer Connection d/ Encapsulation Gas Piping Gas Test _ — Q Appliances Final COMMENTS: Final Utility Notice / _ / % S1 (Gas) 7- 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 1 Final O ility Notice (Perm) R L'{_ ,�{ Tti_ril` ,* �" -�r�, l' °rs �; { r. ; ry .•;AJC �!,i �q ={ � �.1 �7�r`t •4 ti .fir ,`t''� R = { g �e t� Y► �, fiR Y►i1F' V � r �� l * RESIDENCE ADDRESS: l Lot L;) -q TM fes. INSTALLED BY: THIS ATTIC HAS BEEN INSULATED T0: `" ADVANCED INSTALLATIONS 81-771 Oleander, Unit #1 Indio, CA 92201 BUILDER:C,6/�C�L61 s0 ro e, 6 9Zzo/ This attic has been insulated to the R -value indicated above, with Cocoon, the high -efficiency insulation. Made from a minimum of 80% recycled materials, Cocoon is scientifically formulated to deliver greater efficiency per inch than other insulation materials. R -value is a measure of resistance to heat flow — the higher the R -value, the greater the insulating power. If you would like to add more insulation to your home, contact your Cocoon authorized dealer. CERTIFICATION: This is to certify that attic insulation has been installed in conformance with the coverage chart recommenda- tions on the opposite side of this card using bags to cover�1XXq. ft btain an R -value of %1 n 1 t ST L S AUTHORIZED SIGNATURE DATE "• 0j. ice. • ,* C�f" -r,. art: -, , 'L J y tv 0 :mss.."4-i � _ ..., is •' cocoon Jfan ifacfured By: GREENSTONE:•.rN A LOUISIANA-PACIFIC COMPANY NOTE: This coverage chart compensates for settling and is for estimating purposes only. Stated R -value is provided by installing the required nunhher of hags per 1000 sq. ft. at 3 minimum installed thickness. Installation of the required numhrr of bags may yield more than the specified mininhum thickness and nhininuun weight per sq. ft. ACILttl coverage will be influenced by job conditions and application techniques, and may vary as much 35 10% without significantly affecting the stated R -value. Failure of the installer to provide at least the required number of hags per 1000 sq. ft. and at least the mininxnn thickness may result in a lower installed R -value. Compaction may occur during installations ahove R-30, requiring more than the stated nwnher of hags to obtain the nhininlU n installed thickness. 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. �>� ,. B-97-TT/G-A tr Cocoon Stabilized Insulation 30 lb. bag ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART R -Value at 19.4 Net Coverage No Adjustment for Trusses 56.7 75'F Mean Minimum Gross Coverage Based on Maximum Net 30.6 1 Minimum Weight Temperature Thickness 2' x 6' Trusses on 16' Centers Coverage Per Square Foot Installed The Weight Per To Obtain an Insulation Minim:Im Bags Square Foot of Bags Required Insulation Should Not Square Feet Required Per Installed Square Feet Per 1,000 Resistance (R) of: Less Than:: Per Bag 1,000 Square Feet Insulation Per Bag Square Feet (inches) Should Not Be Less Than: (Ihs.) R-50 13.5 20.5 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 Sidewalls (pressure filled-densitv 2.0 PPCFI 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 1 .917 36.1 27.7 1 ��ttit1t r Coachella Valley Housing Coalition Plaza I, 4S-701 Monroe Street, Suite G., Indio, CA 92201 TEL: (760) 347-3157 FAX: (760) 342-6466 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 24 OF BLOCK 55 OF UNIT 5 OF SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 63 OF MAPS, RIVERSIDE COUNTY RECORDS. �- �.� q Date ✓&LDA IMELDA MULLINS Building Address J Sr — t'�/0 Ave C, yf f t�• r ,+;'+-�'c.�,,,L�;fr.r,r...s-.r�tiC�,,ac.e:...� r ulcv P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO I�AN� LA QUINTA, CALIFORNIA 92253 Mailing Address "� City Zip Tel. ContractotOWAI G� (.41 LV Address Tel. State Lic. City & Classif. I Lic. # Designer Address Tel. City (Zip a (State 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 effect. 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, 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 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 thathe is exempt therefrom, and the basis for thealleged 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, Me owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 1-1 1, 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.) 1-1 1 am exempt under Sec. B. & P.C. for this reason . Date Z Owner )WOW— ®W 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 C) 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 pemril is for one hundred dollars ($100) valuation or less.) I certify that in the performance of ing work.for which this permit is issued, I shall not employ any person in any manner so as to become subject to the it Compensation Laws of California. Date Owner NOTICE TO APPLICANT., d, 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 Ihereby 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 if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above informationAs correct. I agree to comply with all city and county ordinances and state laws relating -to building .� construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. •Signature of applicant Date x,�,;,b;�Mailing Address Validation: City, State, Zip �"'"' - sneswd...*wM...-..•.+..r6uvw.. WHITE = FINANCE YELLOW APPLICANT PINK = BUILDING DIVISION a..-.1r, BUILDING: TYPE'C9ONST. OCC. GRP. A.P. Number ?73 —12.s _®off Legal Description Project Description SIN4 L " /L�,C IQ a/DC7V�� Sq. Ft.No. ) No. Dw. a Size�� Stories / Units J r/ New v.,. Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated 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: S V Desert Sands Unified School District 477950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 6/16/98 No. 17188 Owner NameCoachella Valley Housing Coalition No. 51-510 Street Avenida Carranza City La Quinta. Tract # Lot # Type of Development Single Family Residence Comments APN # 773-125-001 Jurisdiction La Quinta zip 92253 Permit # Log # Study Area Square Footage 1,215 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 1.93 X 1,215 or $ 2,344.95 the property listed above and tliaf buitdirg-J' permits and/or Certificates of Occupancy for this square footage in this proposed project may now_ane issued Fees Paid By Cashier Check/B of A/David Brudvik Tle!ephonerr'347s -� - Name on the check, C By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Payment Received $2,344.95 Check No. 2009914990 Signature NOTICE: Pursuant of embly 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 ru om 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 collect them on the Dislrict('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 11