9807-208 (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
CVHC%k U13168
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). <
(x) l,, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
2O/I am a em7,t under Section , B&P.C. for eason
t el of Owner (�L�+/rr7
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.'
( ) 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 r Policy No.
a'r �Iti f?� Xj J�!ln tet�C E 1 rR� Ved7 Aa 11v 0096
(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 Ifo' 'th comply with tho a ov sions. t
,/Date: = Applicant1+ .
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 authoriz�pjepresentatives of this City to enter upon
the above-mentioned property fo In pection purposes.
Zature (Owner/Agent) Date
BUILDINGPERMIT PERMIT# CONTROL#
VALUATION $77,640.70 LOT 3 TRACT LA72 4 3
DATE9JA A
JOB SIT � -tr
ADDRESS i"40 iWENIOA 4.:1'iRRANZA
APN
773-261410
OWNER
CONTRACTOR / DESIGNER /ENGINEER
JAIME GIRAC7A J11
OWNER / WIDER M '1 IIY1110
tiyvDIO �'t1 32201
�/
P! f 60) 34 r -31 V - CBMI,
USE OF PERMIT
SINGLE FAMILY L EJ11140
t,, -WT.It1-1'1' DOFS NOT MCLUM' DLOC1:. W. LL OR POOL- 75% PLAN
"P., C'T C0N1`:1.1'1'UC,"MN 1,215.00 ak
1''ORCtR MA` TO 102.00fS
.
ltt' RMJf_J1tF;[ :'It S�Al.ul} 8
trI-..•P
i
.
I EiAY R 4,�Ys:SI'►k.Yfi9% 1>�.,A , of 0..+1 NS's .Ri ICT11,� 1 Tr
7, �'�i'kf.
CONSTRUC'C1 IN FTE. 101-0004:18-000 3$40.50
P:t, AN CH1PC'1i. FEE 1014000-439-318 $114.03
l< 1130'11ANS ICal: RE-. I01,400-42.1.000 $40.50
IffX(' ICAI.FEE .t71.00f1t1-x:20-LiiiO 317.6.5.5
PLUMBING FEE 101-000-419-000 $12.1.50
S'cRO7INO MOTION F'Eri-.811rM 1017000.241-0(m
GRADING 1M 10.1-•000-42z>000
W-000-443.342 $1,716,39
P101€:.1 SE. PLAN 101-0t)0- 441.-345 ��5.i1)
SUB-TMAL c.OTMIMi1i.:'I ON AND PLAN CRECK
$2,702.a
L 1.SS PRE -PMD Furl;
50,00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
r OPERATION
DATE
INSPECTOR
OPERATION
DATE I
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
ho
Return Air
Steel
G
Combustion Air
Roof Deck
- (- i
Exhaust Fans
O.K. to Wrap_
I _Q Q
5Y
F.A.U.
Framing
— Q
S
Compressor
Insulation
- =
S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- 4
Drywall - Int. Lath
7—/3 —, 4
5-7
Final
Final o C6 S
BLOCKWALL APPROVALS
POOLS - SPAS
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
S=� Y� g S T
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) 5
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Furfures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
s
Final _ _ -f-
Stility Notice (Perm) `l �(/ eT S/
COMMENTS:
T4ht 4 4 "
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
a(s,
Address ,
CityZi Tel
_"
State Lic.I City
& Classif. Lic. #
Arcn., tngr.,
Designer
Address
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 Code, and my license is in full force and
effecI
.
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 thisalleged 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.: 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, 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.)
I 1 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 applyto 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.)
17 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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. 3900, Labor Code.)
Policy No. Company
n 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 permit is for one hundred dollars (E 100) valuation
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. -
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 it 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 alfplicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number _17-6— alll -001C)
Legal Description l n `1
Project Descriptions, ��1�. c�it��I,t-1 xs,,Uenee
Sq. Ft. No. No. DIN.
Size Stories 1 Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
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
Notice:
Document Cannot Be Duplicated
Date 7/31/98
No. 17419
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameCoachella Valley Housing Coalition
No. 52-440
City La Quinta
Tract #
Street Avenida Carranza
Lot #
Type of Development Single Family Residence
Comments
APN # 773-261-010
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 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 that building;
permits and/or Certificates of Occupancy for this square footage in this proposed project may-4o�v be,issued
Fees Paid By CC/Bank of America/David Brudvik Telep' kt me 347-3157
Name on the check
By Dr. Doris Wilson �r .
Superintendent
Fee collected /exempted by
Signature
Juanita Green Payment Received $2,344.95
Check No. 2009916226
NOTICE: Pursuant of A&sembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 9D -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 t
ecto
wllthem 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
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
54625 AVENIDA BERMUDAS. LA QUINTA CALIFORNIA 92253
760.564.0884 PHONE • 760.771.3606FAX • WISH@ICWIA.COM
Regarding: CVHC 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.
S' rely,
- '
aa
ennis S. Wish PE
Structural Engineering Consultant
�tr1 ESS/p\
v
S. WISH
NO. C•041253
UJI
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
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 13 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.
xz �-=
Date AIME BELTRAN GA CIA JR.