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9805-048 (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 and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date C V A1C 12/31198 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: ()e 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 a cempt.,under Section , B&P.C. f x t is reason �ateSignature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury onej 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 issued. My workers' compensation' insurance carrier & policy no. are: Carrier Policy No. '1'Rs.l'CK; 'MUR€`.NCL7, I A2007 4370 00 96 (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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fo hwith comply with thovisions. Pate: Applicant A - Warnin .Fa ure 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. 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 ins ection purposes. /ignature (Owner/Agent) >-- Date , l r BUILDING PERMIT PERMIT# '�• CONTROL# 9805-048 DATE 1 VALUATION �77�64o.70 LOT 21 TRACT 4574 JOB SITE ADDRESS 51-`560 AV�,'ilNIDA Ckk�S1E�M�1}�ti APN OWNER CONTRACTOR / DESIGNER / ENGINEER VAI.Ft. -0 &tiiDAAV.1' S OWNER 1 f3t_I)l, E.R.'lVE m. C:V.HC tNDIO 0k 92201 (70)34?' 4157 CMA USE OF PERMIT SED F,fD - (313fS1:)'ROOIVO P-A-:Ui'rT 1,)O S NOT INC LUf)E- )3LCK7k WAAf,S GR . laCaUl., fyf.AN i.'if~t,C�,1�(i!2 I'lUN Ct3'' iJS REI i�5`;fo t<,`t'aFt I4fi1.P TI:t�; q ;; :.: i '1' fSfSI.YA.NC'F. OF 5Af1,1>uPLA.iV :'k'A. MAY 14 11ZAC`' C O',NS I.MJC110N 1,215.00 SF POftC:Cf/1''El"CtO lti7..C�y Sig _ 0A1ZAGV1-CAlfvl10R. ' 111.6.00 S 9 �./ 0" �h 1 � �� -�• Uf s Eft±Ittet a31 u C CST OF f;"CI','NSTRUCT101"wv C`0.N TR1JC't10N FU k01-000-418-0110 $540.50 ^f P)_, �1 'C'Fi1if y;• ♦i :M^ t i 1 'f N!i-.2 9•+ i �,�3 $114fl! V x,°firl:1i12Cr1T.'f sE 101-000-421-000 $40.50 EIJX P AXCA►. rM, 1.01-000-420-000 $1J6.55 PLUMBING i'i?.b 101A)00_4194)00 $121,50 M('YIION .I: � - 'R .140 0 t 4 W-`�'4i-!1�1 $7.76 r:7�9*k!n/ipY140 Q n rQ-R Dil4V I�Li' 101-000-423-000 $n0.G0 1NTR&STRUCTLJ. ME '225-006-443-34.2 51,714,39 f4 C;.I.SE,KIAIt`t 1171-010-441-345 SUP-itMAT. CCINw"I'1OJG"i' ON ,ilNr? :P ANCHRC.K �iP7ff� 21 :LESS PRE_13M.11) .1"11 S MOO RECEIPT DATE BY P DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPR VALS MECHANICAL APPROVALS Set Backs All Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck,�?j Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation fs _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath ,Z— Dr wall - Int. Lath Final Final 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 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 Lateral Pool Cover Sewer Connection ncapsulation Gas Piping Gas Test qq S -' Appliances Final COMMENTS: Final Utility Notice (Gas) .7 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 Final tUtilily Notice (Perm) ��j Tiat 04" P.O. BOX 1504 APPLICATION ONLY BuildingC"' X560 A110- 691P � 78'495 CALLE CALIFORNIATAMPIO AddresJ Kf< QUINTA, ORNIA 92253 Vk1_ &'Yz10 SFW rPS Mailing Address City Zip Tel. & CWNOX f34 J L 27erZ Zip State Lic.I City & Classif. Lic. # Arch., Engr., Designer i0p—s D1i 516!✓ 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 Cade, 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,Business 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 8 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.) 111, 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.) I'7 I am exempt under Sec. B. & P.C. for this reason Date ?+ OOwner ✓ N`-"�" 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'COMPENSATIONINSURANCE (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 thg 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 NOTICE TO APPLICANT., If, 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. (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 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 Mailing Add City, State, ILDING: TYPE'CIONST. OCC. GRP. 1. Number Legal Description / - Project Description S��1e i"e!"1'&y`et5l � Sq. Ft.No. No. Dw. J Size 1215 Stories Units ff Newer Add O Alter ❑ Repair ❑ Demolition O 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: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION THIS ATTIC HAS BEEN INSULATED T0: 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. ncocoo­ " - .Itnnt farJured 8r. CREENSTONE:•.`" A louit I ANA. PAC 1 rl C COM PAN .NOTE: This coverage chart c'lmipensa(vs for settling and is for estimating purposes only. Stated R-lnlue is provided by installing the required number of hags per hFq sl(. (t. at a nrinit n in installed thickness. Installation of the reyuiied number of bags inay yield morn than die specified minimum thickness and minimum iveight per sq. (t. Actual coverage will be influenced by job conditions and application techniques. and may Cary as much as 1016 without significantly affecting the stated R -value. Failure of rte installer to provide a least the required number of bags per 1(11(1 sq. (I. and at least the mininuun :Iiickncss may result in a loner installed It -value. Compaction may occur during installations above R-30. requiring more than the stated number of bags to obtain tate minimum 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. 8.97-TT/G-A RESIDENCE ADDRESS: Lot C;11 s�o C . CI- r-ra- n z.ql �- uk � n AAs- 9 --2- z 5 3 INSTALLED 8091 01e-CLn,&e-,- u.n Ir -a i -o-� CQ Q 9 Z-zo 1 BUILDER: �+� I H C S -10 1 00 z3 r✓ n �j.�, l C 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 4-0-bags to cover 10b4 sq. ft. to obtain an R -value of 3 4 1 ri1 INST LLER' AUTHORIZED SIGNATURE rDATE Cocoon Stabilized Insulation 30 lb. bag ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART 51.4 19.4 Net Coverage No Adjustment for Trusses , 56.7 II -Value at Minimum 5.5 Gross Coverage Based on 7SF Mean Temperature Thickness 2' x 6' Trusses on 16' Centers Maximum Net Minimum Weight Coverage Per Square Foot Installed The Weight Per To Obtain an Insulation Minimum Bags Square Foot d1 Bags Required Insulation Should Not Be Square Feet Required Per Installed Square Feel Per 1,000 Resistance (R) of: Less Than: per Bag 1.000 Square Feel Insulation Per Bag Square Feet (inches) Should Not Be Less Than: Obs.) 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 i 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 foressure filled -density 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 1 27.7 1 Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 5/13/98 No. 17024 Owner NameValerio & Aida Santos No. 51-560 Street Avenida Carranza City La Quinta Tract # Lot # APN # 773-125-004 Jurisdiction La Quinta Permit # Log # Zip 92253 Study Area Square Footage 1,215 Type of Development Single Family Residence No. of Units 1 Comments 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 that building permits and/or Certificates of Occupancy for this square footage in this proposed project-may'now be%issued Fees Paid B Cashier Check/Bank of America/Bill Standefer Tel �' Name on the check By Dr. Doris Wilson , r. r; Superintendent !r, . _ ;• 4 Fee collected /exempted by Juanita Green Payment Received $2,344.95 Check No. 2009914079 Signature NOTICE: Pursuant of Assepbly 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 collect 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 I 9 Coachella Valley Housing Coalition Plaza 1, 45-701 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 21 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. p ' - OG-bc,'o 'CV40 S - Date Valerio Santos v g111111791111101� Fw'm " f: \sfa m ily\a n n a\m iscfo r\attn yfa A j'j rk y. S a rri- o s Aida Santos