9805-045 (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
CVE1C 1.1311'95
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:
(X) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( k
II am a tempt under Section B&P.C. for this reason <
ate S.. �� Signature of Owner 0C
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.
(A 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�t7 Policy No.
'l1WCC, IINSURANCE 1 1#2,31;7 03'10=3 (0 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
A
"owith omply with thos'�ovisions.
ate:pplicant�""r
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 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
the4bove-mentioned property for' spection purposes.
Signature (Owner/Agent) "' Date
BUILDING PERMIT PERMIT t�soc- CONTROL#
0415
DATE VALUATION s�,s ► LOT j (y TRACT77 4 9
Ab
�// 4
JOB ADDR SS 51-630 AVEN.IIDA CAEt,�dANZA
APN 77� �2S fE9)'�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1,10,1AESI`i ER SA TOS
OWNER /BUILDER W1114 CWC
43741 NAVAJO ST
455701 MON ROE ST Slt C;
INDIO CA 92201
:tN.010 CA 92201
(76U)-1'17-31 57 C:K#€
USE OF PERMIT
SFD
fi ;
&FT) ,• (48601WON() s ERNUT DOES NO i INCi,eiM MOL'1C WAL1.5•OR
'POOL. KNN C,f- ECK PORTIGN OF 1/EYES R.9011OED 7S°to`).!f; x�3 tatlll. mpl...tn:
f�a'Utli>dfl C�1:' �>AfVFiF. I'I.AN `6'i�l?F:. F
•
cfl`� j �t._ .
a11t1C'T�.va'v5'ti�t3�"1'1013 1,302.00 SF
l°t .[tt;I11E'�lI.IC� .59.00 MAY
141998
'L;rf�l2.Atiil:%{i�10:Ci:'U3�'i'. 5.17.f1Li SF
pp pp 0
p 0 TA
1< NT,M.AXED W'ST OF CCINSTIRtlft"[ ON,
TS2,946.51
F .if!iKN[fT FUi.9 SVAfiWIARY
Cd(NS4R.IJCT1 0N"I-E'IJ 101-000-4113-000 $563100
fell f ;Ns CIRC , s� E 101-000~439-3I.8
Nff Tt1N 3C r1T.,1"i f7. 101-000-421=000 $4Ii, Er7
U.UflCn1tdC:AL FRE 61-000-,vo-1 30
PLUMBING ! p-6 . 10:1 -MO -419 -OW $11 ! 9)
S'l'hONQ MOTION FIF`F' -14,511) 101.031)-241-04113
0IdsV0IN0 ��tfl:'.I;: 101-000/0; 423-000
y r t csy2po.u�0+
f' i.�(�.L:�,1•.!.'.'IS 22-5-M-"3-342 �f�tY30.ff
PREC)SHref:AN 101--OW-44I-345
ST B-1O'1.ALCONS"MtJ(".i ONANDPt ANYC R CK
LES.4", 1 U,,-,PA[D FES
10.00
�F�Aii.,.)L' .;:f�ti�d1"i 3i'.#�'a;+S All !: iYCIVV
53,534.6+
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
YAC..
Ducts
Slab Grade
-
Return Air
Steel
_
Combustion Air
Roof Deck
-�
Exhaust Fans
O.K. to Wrap
—f
F.A.U.
Framing
a r/d -
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
_!7
Final
Final
_
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Footings
Electric Bond
Main Drain
Bond Beam
_ff
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
���E�
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
/
Appliances
l
Final
COMMENTS:
Final
Utility Notice (Gas)
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
I
Final
Utility Notice (Perm)
_
cocoon
THIS ATTIC HAS BEEN INSULATED T0:
R-0
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 now - the
higher the R -value, the greater the insulating power.
If you would like to add more insulation to your
i
home, contact your Cocoon authorized dealer.
Cocoon
,11a,rr factnred 13...
GREENSTONEEN "
A LOUISIANA-PACIFIC COMPANY
XUTF: This coverage than compensates for seuling
and is for estimating purposes only. Stated Ra;luc is
provided by installing the required number of bags
per 1000 KI. It. :it a minimum installed thickness.
Installation u( the required nutuiv, of Ixlgs may yield
more than the spc-cilied minimum thickness and minimum
weight per sq. ft. ACIIIal coverage will be influenced
by job conditions and application techniques. and
may Vary as much as ID"L without significanlp
affecting the stated R-valuc. Failure of the installer to
provide at Icast the required number of bags per
1000 sq. ft. and at least the minimum thickness may
result in a lower installed R -value. Compaction may
occur during installations alxtve R-30, requiring more
than the stated number of bags to obtain the
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 8197.
8.97-TT/G-A
RESIDENCE ADDRESS: Lo 1(O
S 1(0 Sly Plc r I-Y,t n g-o-
tea- Qu I n i7a 9 z -z 5 3
INSTALLED BY������Q��
53�`1�11 Dlear,c�er un. -r �
INcQ �y G Z2-01
BUILDER: Cl V 14C_
yS7or MOO) C 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 40, bags
to co%er LLIJsq. ft. to obtain an R -value of 30.
Lt h nn G
'7 I
I STALL R'S AUTHORIZED SIGNATURE DATE
Cocoon Stabilized Insulation
30 lb. bag
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
Net Coverage No Adjustment for Trusses
R -Value at
Minimum
Gross Coverage Based on
75°F Mean
Temperature
Thickness
to
z 6' Trusses on 16' Centers
�=I.wra
Minimum Weight2'
Per Square Foot
Installed
The Weight Per
To Obtain an
Insulation
Square Feet
Minimum Bags
square Foot of
I nst
Installed
Square Feet
Bags Required
Per 1.000
Insulation
Should Not Be
Per Bag
Required Per
Insulation
Per Bag
Square Feet
Resistance(R) of:
Less Than:
1 000 Square Feet
Should Not Be
(inches]
Less Than: (lbs.)
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 tilled -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 36.1 27.7
Tiht aF 4 4"
Building
Address S -1-60060o Amu -n clua41vz
/./,I 'EsTIyEr? SAAl-ros
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing 3 s 7 /% �AV -TO S� ���
Address V4
-TO
Zip Tel.
1AID1 o 13117-- BS ilZ
Contractor
OU/b/M 13U1L12&i2
8 Classif. I Lic. #
Arch., Engr.,
Designer Diems -*MS .04S�S / d)v
Address Tel.
-7 x-13
City Zip 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,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 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, euisness 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.)
[A 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.)
i7 I am exempt under Sec. B. ti P.C. for this reason
Date *1! Owner 0wNO-72—
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. 0 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 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 a0plicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP,
P. Number 7-73- 125'^o®9
Legal Description n
Project Description 5%4�� ��A
;if esid&4[A_;'
Sq. Ft.No. % No. Dw. /
size Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE 40'`
Date 5/13/98 APN # 773-125-009
No. 17021 Jurisdiction La Quinta
Owner NameVelia Esther Santos Permit #
No. 51-680 Street Avenida Carranza Log #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1,302
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 1,302 or $ 2,512.86 the property listed above and that building
ctm.u� suedPermits and/or Certificates of Occupancy for this square footage in this proposed ro eaYo
eli
Fees Paid By Cashier Check/Bank of America/Bill Standefer Telephone 347-31 �7
Name on the check >
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,512.86
Check No. 2009914079
Signature
NOTICE: Pursuant of A§tembly 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
Coachella Valley Housing Cation
_
Plaza I, 45-701 Monroe Street, Suite G., Indio, CA 42201
TEL: (760) 347-3157 FAX: (760) 342-6466
® T• •
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 7 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.
F li-ja -�al�t
Date Velia Esther Santos
Date
f. \sfa m i ly\a n n a\m i s cfo r\attn yfa