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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
CV11C 12508
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:
( ) 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).
(>0 I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( Hap,exe pt under Section B&P.C. fo i5eaason
pate! C/ Signature of Owner A-0222
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.
(iq 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:
Cartier Policy No.
(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 sh 11 forthwith comply with those prov ton ,�
Wate: Applicant
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
the above-mentioned property fo ms ection purposes.
Signature (Owner/Agent) i�.:rsE•gG-^°" Date
BUILDINGPERMIT PERMITk }� CONTROL#
��tarz�i 72 14 5
DATE VALUATION %77,�,�
�.0 LOT 16 _ TRACT 0� i � ,
0 41,v--)
JOB SITE ADDRESS 5� X70 A'VEi`�IIDA C'.t�ltlL7Atti ZA APN 77X?61.-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A.UR.EWANO 100P ENO ROD IGUEZ t NKNEK / �iC.�1LDER. Cl'1"C'.�( C ticy
INDIO CA W-201
(7cs0).147-3157
USE OF PERMIT
SNt" X VA -MRS UWE1..j.AKU
S -tri) » PQAJUIT L3C+i S NOT'!KCUF013. BLOCK WA. J. OR POOL. °75% PUN
t;.4R,Xt21:,T)LI :r1QN AP1:LIFT).
'1'R At",".1' CONS'i:t2'(lC'VIC:,iv 1.20,60 8F
110Rf:3VP1fA3`.1S? 1W.00 w;
G1%kA01YCAf010IVV 5Y5.00 sr,
SWA -TUM,, C;{:'>_►J91'KIC"1T N ;AND PL !N C HECK�v1,',4)w 21
LESS PIZE-f'rilt�la; ,S X)
To. -cm, vwrorr vi E8 .d)lJi�,'1 OW' 1 52,702.23
RECEIPT I DATE I BY, I DATE FINALED J INSPECTOR
C.0�� OF t�.,.1,.d'.aOT
Raji." ION
77,14411). I'll,
y q� /Agy''q pd'
,P,.Yl1V>f.W ,ly R� a '� suki�,ifWAE6 Y_
PLAN Q14ECK Mr-
101 OW 439-31 8
Sl.t.�t.fl3
4t1?C 1AN%{ AL 1,'3513
!1}1 -il l'- 0(1
S40.50
PLt1fL1'SIt+fG FirF
101 -000 -419 -OW
S12.E, W
STRONO IN101T!:ON MH 111:RD
1 of -0010-241-000
"16
'GRADING FEW
101-000.421000
520,00
INTI- A.STRffC1URI FEE
225-000-443.342
16.N
Pf2EVff9.13%AN
101-000441-345'
S`23.c�0
SWA -TUM,, C;{:'>_►J91'KIC"1T N ;AND PL !N C HECK�v1,',4)w 21
LESS PIZE-f'rilt�la; ,S X)
To. -cm, vwrorr vi E8 .d)lJi�,'1 OW' 1 52,702.23
RECEIPT I DATE I BY, I DATE FINALED J INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
I
Underground Ducts .
Forms & Footings
_
Ducts
Slab Grade
L.09
ReturnAir
Steel
Combustion Air
Roof Deck
-3 - C
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
,$
Compressor
Insulation
- - S
7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
ST�
Drywall - �Int. Lath
L�'o.&A-c
--v-
Final
Final
�� C 7 £ 4
s
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
Waste LinesJn
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral_
Sewer Connection
a
/
Pool Cover .
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
_ _
Utility Notice (Gas) , C� £ 5
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
: G. F. 1.
Smoke Detectors
�Jemp.'Use of Power
Final
Uti.14 Notice (Perm)
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/31/98
No. 17421
Owner NameCoachella Valley Housing Coalition
No. 52-370
City La Quinta
Tract #
APN # 773-261-007
Jurisdiction La Quinta
Street Avenida Carranza
zip 92253
Lot # Square Footage
Type of Development Single Family Residence
Comments
Permit #
Log #
Study Area
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 that'—l'Iding u
permits and/or Certificates of Occupancy for this square footage in this proposed project rray now,i e issued
Fees Paid By CC/Bank of America/David Brudvik Tele hone =
Name on the check
• L
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received
Check No
Signature
$2,344.95
2009916226
NOTICE: Pursuant of As mbly 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
N
Coachella Valley Housing Coalition i
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 16 OF BLOCK 81' OF UNIT 10 OF SANTA CARMELITA AT VALE LA
QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 70 OF
MAPS, RIVERSIDE COUNTY RECORDS.
q r�Jl2m
Date AURELIANO. MORENO RODRIGUEZ
June 24,-1998
Mr. Daniel Crawford - Inspector
City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, California 92253
STRUCTURAL ENGINEERING CONSULTANT
1. 54-625AVENIDA BERMUDAS. LA QUINTA CALIFORNIA 92253
760.564.0884 PHONE • 760.771.3606 FAX • WISH@CWIA.COM
Regarding: CIVHC Plan 320 and 420 - Truss Calculations — Group 9 (Typical all La Quinta Projects)
Dear Daniel:
I have reviewed the truss calculations from Imperial Roof Truss which is to be used for the roof construction of the 3 bedroom and 4
bedroom homes in La Quinta. The truss calculations labeled "320 Plan" are for the 3 bedroom plan that is associated to the "96-051"
job number listed in the lower right corner of the architectural plans. The "420 Plan" truss calculations correspond to the "96-052" 4
bedroom drawings.
I have reviewed the truss calculations to confirm the capacity of all design loads drags and bottom chord loaded girder trusses. I have
found each to be in compliance with the intentions of the structural design I have also verified that the roof dead loads used in the
design of the trusses exceed the design loads on the structural calculations. The truss calculations are more conservative and therefore
acceptable.
The Truss calculations will be used the self-help La Quinta Project - Groups 4, 5, 6, 7, 8 and 9. Each group will use the same plans as
those mentioned above that these truss calculations conform to. I have provided a separate letter referenced above for each group.
These are intended -to simply the City's records and allow a separate approval for each block of homes. Coachella Valley Housing
Coalition can provide the addresses for each lot in each of the groups listed.
Please contact me at your earliest convenience if you should have any questions or additional requirements.
Si rely,
- '
mia
ennis S. Wish PE
Structural Engineering Consultant
.� DEI:NIS S. WISH
No. C-NI250
1s - crv�_� �.
STRUCTURAL ENGINEERING FOR • CUSTOM HOMES - REMODEL • COMMERCIAL • LIGHT INDUSTRIAL - SEISMIC RETROFIT & REPAIR • UNREINFORCED MASONRY • RETAINING WALLS & FOUNDATION • REPORTS:
DAMAGE ASSESSMENT • NEW ROOF • INSURANCE CLAIM • DENNIS S. WISH P.E. HAS BEEN A MEMBER OF THE STRUCTURAL ENGINEERS ASSOCIATION OF SOUTHERN CALIFORNIA SINCE 1983