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9805-050 (SFD)N W O =) M � CY �W� oZ� (.C)0o H� �. J W N Z LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of -perjury that I am licensed under provisions of Y Chapt& 19;(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 CVf1C Date Signature of Contractor ta131/9S OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( 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) Oil am exempt under Section , B&P.C. for this reason ti tPate a Signature of Owner .1�►_ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of. perjury one of the. following declarations: (`) Ihave 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. Se( ) I have and:Will maintain workers' compensation insurance, as required by ction 3700 of the'Labor Code, for the performance of the work for which this permit is issued. My: workers' compensationinsurance carrier & policy no. are: Cartier r Policy No. TRUCK, la S:lltr"�2�iC'i D A20ttro ,+ ' 00 9th '(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, XCode, I shall f rthwith comply with t ose provisions.. Applicant— Warn allure to secure Workers' Compensation coverage is unlawful and War g p g 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 theeaabove-mentioned property for inspection purposes. �Slgnature (Owner/Agent) Date BUILDING PERMIT PERMITk CONTROLit y;1►5-tt:i41 ��C1� %Q 8 . DATE VALUATION LOT `1'2 TRACT 17,474 C JOB SITE ' ` ADDRESS' APN !%r�-1 OWNEY(R CONTRACTOR / DESIGNER ENGINEER t A A +7 4�f e � wt 4L S �+c� JUAN' &I RMA. QA AN1 IE1.ES t �y CV OWNER, / []iyllrii R. Y J11rR 1. 1111 .n .PO BOX' 492 4570 i iv ONROE ST SM G• INl'IO CA 92201 INDIO ('-,A �22l3i .060)347-31-57 t BL# . USE OF PERMIT S.i'' D SM - (i MDt: OQIV�) PFM& DOES NOT ,tN'0,00k 51JXX W.M.-IA OR PCIOia, KAN CHECK P0K11(;�.N OF Ffl-".1S !t};,D1 CE0 7Y.1. Vok,&UjJ rlP1 C.. ISSJJ,4,+1C_9 OF SAltIE. PLAN ,nyt; VMCi CONSTIVI TION 1,3102,00 SF 1101W.WPATIO 159.00 SF . td ] 4 190 Kuri.'ii.flC1�sfC;At31't�.i�'1' Sf.'%.ilU Sl% . •.AiY FLa• ��gra . EN a IMA 'I E+ iii CX,)ST OF t.Yi?NSTdtUC 100 32,046.50 � ��a�r�r�:�tc:F1'�r.�rr•�ef:� 1a�-(�(�-a1.�-(x�� �.�.f1i� 31 is Z) PL :Aid f,,!w•ilT CK P -T 101 -0f)(1 -439-31,R i 10A -000"4A 1 - t ()0 •ti(}.Sid 101 -OW -120,000 $.t i 4►.4 t P#,EJ ABIs Q'r'EE 1U.1 -OW -419-000 $d',1. 0 CRC9NP MOTION ROF - 114 FK'(P! .!0 1-WO.'141410f) �� 2 Ol�ti„)INC. �I.`'ll 101000-4`'3.01}0 INFRAST uKTUAJiFRE 225.000-414,:-342 11,11.U;Ctsf PLAN, 101-1)0{14111-345 $25,00 Sti (:t?Nf;rli'k..I T'tt7i�! AMD PL;F111�7'!�C�,1• CHECK S2,R3465 G� 1..ES'S ..1*1R_.'(.•,.'.'A1DfEES $000 9'MAL 8'J;itMIT Iti.EM 131-1E NOW $2,934.01; L RECEIPT DATE BY DATE FINALED INSPECTOR '�t a - . INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION. DATE INSPECTOR BUILDING APPROVALS_ MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade / Return Air Steel Combustion Air Roof Deck /Q f Exhaust Fans O. K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath — z 16 Drywali - 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 Encapsulation Gas Piping Gas Test Appliances 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 ut L Final Utility Notice (Perm) COon THIS ATTIC HAS BEEN INSULATED T0: This antic has been insulated to the R -value indicated above, with Cocoon" the high -efficiency insulation. Made front 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 deader. �G ®r"IC 0 Or) !lrl )III%rlcllrrlxl HI' GREEN ST0NE:•:r" A tO Url rAx A.♦ACrr c c..F 1 \01'li. 'rhis c-c•rtge chap rrnnpcnsancs (or scaling and is for estimating purposes only. Stated R -value is provided by installing the required nunitier of haps per loot sq. h. at it rniniinurn installed thickness. h1�61llallon of the required numlxr of hags may Field more than the specified nlininunn thickness and mininnum ccergla per sq. It. Actual coverage ill be influenced hr job conditions and application techniques. and stat can- as much as 10^4 without .significantly affecting the stated R -value. Failure of the installer to pro, ids at least life required number of bags per loon sq. ft. and at least the minimum thickness may result in a lower installed R -value. compaction may occur during inaallations al,o%v R-30. requiring more ih:m 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 8/97. 8 -97 -7/G -A RESIDENCE ADDRESS: L(_5ta­N {" S I11) 9U lP Po,r-ra n zcc L SA ►�ZZ-S 3 INSTALLED 817'l I UI-eC4r,der tD 9z X0I BUILDER: / -i ,� � GlZ"ZoI - 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 ! Z bags to cover 1 :I�sq. ft. to obtain an R -value of -9:9 4 a INSTA ER' AUTHORIZED SIGNATURE DATE Cocoon Stabilized Insulation 30 lb. bag ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART 51.4 19.4 Net Coverage No Adjustment for Trusses 56.7 R -Value at Minimum 5.5 Gross Coverage Based 75°F Mean Temperature Thickness to 2' x 6' Trusses on 16' Centers Maximum Net Minimum Weight Coverage Per Square Foot Installed The Weight Per To Obtain an Insulation Square Feet Minimum Bags Square Foot of Installed Square Feet Bags Required Per 1.000 Insulation Should Not Be Per Bag Required Per Insulation Per Bag Square Feel Resistance IRI of: Less Than: 1,1A)0 Sgbare Feet Should Be (inches( Less Than:n: (lbs,) R-50 13.5 20.5 48.6 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 3).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 I 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 1U.7 .322 102.8 9.7 Sidewalls faressure filled -density 2.0 PPCF) R-13 (2 x 4) 3.5 51.4 19.4 .583 56.7 1 17.6 R-20 (2 x 6) 5.5 32.7 1 30.6 1 .917 1 36.1 1 27.7 Desert Sands Unified School District Notice: 82-879 Highway 111 r, Document Cannot Be Duplicated Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 5/13/98 APN # 773-165-003 No. 17026 Jurisdiction La Quinta Owner NameJuan Zarraga Angeles Permit # No. 51-790 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 permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By Cashier Check/Bank of America/Bill Standefer Telephone; . Name on the check r� By Dr. Doris Wilson 7 - Superintendent �+ Fee collected /exempted by Juanita Green Payment Received `2;:5.12:,6. A, (�,, ' � Check No. 2009914079 Signature \. i'/,/!�%12�X17i L�L� _�- NOTICE: Pursuant of Assepflbty 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 fron*fhe 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 Coachella Valley Housing Coalition Plaza 1, 45-701 Monroe Street, Suite G., Indio, CA 9220I 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 22 OF BLOCK 58 OF UNIT 5 OF SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN BY MAP RECORDED 1N BOOK 18, PAGE 63 OF MAPS, RIVERSIDE COUNTY RECORDS. _ 6 - n . (2ez� Date i ' zarraga A.4eles Date f:\sfamily\an na\miscfor\attnyfa y� ,