9801-082 (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
Da 6 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) 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't6e property, am exclusively contracting with licensed
contractors'to construct the project (Sec. 7044, Business & Professionals
Code).
�() I am exempt under Section , B&P.C. fo�tktis reason
,�
Date 2 �/ Signature of Owner
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.
(k) 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.
T141,110K 9N1,C3URPJ4Cr-'1 X2007 4370 W) !Y,
(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 fortwith comply with th se�provisions.
d Date: 2 / 4 4Applicant AKZ= �—
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 for'ngAection purposes.
Signature (Owner/Agent) Date 6
PERMIT # CONTROL #.
BUILDING PERMIT
DATE VALUATION 1,.�Ce'g.x4E LOT. k TRACT ro
7.�'i
f 2Gf� aGJOB
SITE
ADDRESS 111-30.5 Eti%`�.P�li,i)�41&+dE�f�.19.6L,Z
APN 77XCf�2'.41.5 at 'ri
OWNER
CONTRACTOR/DESIGNER/ENGINEER
6:'t) �Rlt,l i.;f.? j 1. fear Sl" (,(rl{.,`1 .•�
i A"' l•. .J I..I 'Y lJa..) 1i.\✓'I\.
0WAFH / 7!'LI 11 [_1% Iy �L'j"!`d.d •�PR-1
i H. • ,.J II.a LI..� \ i \l 1.
pf_03ox ) v�:y .
43 70 i MONROE OE 53 IE
(.'A 9a 236
INDIC) C.A 9"401
USE OF PERMIT
&F C)•• 90-646C i)C)is l Ni.:,'i WALLS OR lk)0 — pi_kN �, J
CHEK i '�.1�.`r1C)NI Of?• .1�j.i& 4E10L ICEi:) 75% POK Nf0,11:'Ii'1 !.S°atiAlvt:f ; OF
3ANIE Pf.. A:N 1' Y IJR. 1 ..•F
A
'LJ 'f '
1`k.AL""3'C�✓i., lfit7C't'f(AN 1,2.f,0.00 1.
K)RC,WPKYKJk 102.00 Sir'
cin n rs�Alt t pig; +° nxg) if. J AN, 2
• '
3 1998
,
a Y
pq,, ¢��7�Y 1a t�p,ae9 ** aa tg��cos, p��^y 6, �^fp^`) �q�• 8-�
_E, s 4 f lW9 it..•Y a JA! co. s,r r�jjl 7l,u Vja @ 44, fic il. �cTi
�
�y
t 71310.,"
0 KR A41 T �+`I4', SU MA Ftp
00N3'rRi, C7I0N F E 101 -0c* -418'-000
c
PLAN (:` - EC`fi R31? 101-PW4,k9-!.V3 4 X114.0t.
:.
dist, f 1AP`fI AL .! f_;1:. 1 C►1-0()(? "1? r t)i7U V().50
FIX.::TR[ AL 1i Lir: 101-000-420400 S116.37
PL IJMl fN0 FI;X, 101-000,11 121. x
53'WON ;' W)TH-JN' F-0- � RESID 101. -*1-741-000
G1't.AL)1,'N i .F Lf' 101-0,00-123-.000 ;�ts.Gii
A
1Ivh14A;;f:eti.fi"Ct.li2i:?FEE 225--0t3()-443.342 �1,'7iti.�t3
f RE0313 PLAN 1E) l -00(P141-.34`s
Is ITV'r()arA1 (`.f -IN. 1"C'A,jC YK)N ;ANF) 1:f(. n N ! I 117('k_
LESS PRE. -PAID FEES
1;*,0AJ10
TUFAL P E £rtF,', [T F Sl; S D1)E NOW
rt
' , J
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR {
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
_
Exhaust Fans
O.K. to WrapQ
_
F.A.U.
Framing ��� L
id ��.
Compressor
Insulation !%�2jAL��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Twvg414
Final
Final
_I64
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
G����
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
QQ`
Pool Cover
Sewer Connection
JC
Encapsulation
Gas Piping
_
—2:5 IT
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
f
Final
U i* Notice (Perm)
I:,11r 1 *nye-.i:'�ji�:
ti
P.O. BOX 1504
Buildin �78-495 CALLE TAMPICO
Address /U)e
QUINTA, CALIFORNIA 92253
Mailing
Address
Zip l jTeL
City
Zip
Tel..
State Lic.
& Classif.
City
Lic. #
Arch., Engr.,
Designer
Address
Tel.
APPLICATION ONLY
R
BUILDING- TYPE'CONST. T OCC. GRP.
A.P. Number -77 s nq ` nj s
Legal Description ir^'"'�13� $LIC 1,-7 1 WIT
Project Description
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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.Susiness and Professions Code: Any city or county which requires a -
permit to construct, atter, 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. Ariy 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.) .
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 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 I I am exempt under Sec. B. 8 P.C. for this reason
Date -owner l+/..n.Pri.e'i-•--/%ii •[s .• t4,GC
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. •O 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
ame
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 tobuilding
construction, and hereby authorize representatives -of this city to enter the above•
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
-City, State, Zip
Sq. Ft. ��j� No. f No. Dw.
Size aa�r 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: IDate Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
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 3 BLOCK 67 OF UNIT 6 OF SANTA CARMELITA AT VALLE LA
QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 67
OF MAPS, RIVERSIDE COUNTY RECORDS.
Date
Date
cisco Lemus Horta
. ► / 1 . 4 a --
MarthdGuardado Horta
Desert Sands Viiffled Scho'01 Distrid":
Notice827879'Highway ,,-1n
:
ridiq,*CA'4h0l.
Document Cannot Be Duplicated
G19-775 3500 .
ERTIFICA EOFCOMPLIANCE
Date 1/22/98 =i Ar.0 # 773-082-015
No. 16540 Jurisdiction Ld"Quiunta
H' 'Permit #.
Owner Name, Oachelld Valley, Housing Coalition
41.
No. 51-305 'Street', Ave.Ramire"i
Log #.
Cit y La Quinta Zip 9225.3
'Study Area
Tract #: Lot # Square Foo'tage 121',0
Type of Development Single Farilily, Residence No. of Units
Comments
At the pres&nt. time, the Desert' Sands Unified School District does- not collect.' fees': on garaiges/carports, covered
patios/walkways, residential additions urider'500 squarelfeet') detached accessory structures or replkem6nt mobilehomes.
It has been determined the above':`h'amed'oW`ner is ek6ffipffrorn paying school fees, at this time due to the following
reason:
:EXEMPTION NOT APPLICABLE
This certifies that school facility.feAjmpios6d pursuant to, Gbve'rnment Code, W80 in the amount of
7
.1.84 X 1,210 -oV$,`2,226.40 fhe pr 1bbv
qpqrty liste�d, ean&that,,building
P and/or Certificates of Odbilpancy for this s ware footage in this., t manow be issued
proposedprojqc -Y
Fees Paid By Cashier's Check/Bank of America
Telephone
NanWon the check'
By Dr. Doris Wilson
Superintendent
Fee collected /exenpted by Ellen Paltino PaymentReceived2.
44
Check No:,: 2006714095
Signature
NOTICE: Pursuant of Assembly Bill M61 (CHAP 59l'9 STATS; 1996) this will serve to notify,jou that iheik �y appi6val period in'Wh 6 you Y, me protest the fees or other payment identified
above will begin to run from the dateon which the building or installation permit for this' project is sissiul-66'or on which they are paid to the.(),istricl(s) or to,another public entity authorized to
collect them on the District('s)(�) behalf,, Whichever is i;alrliair.
Attach a copy of county or city plan. check,applichtion, ormto,district copy,,,for.all-.-,Waivers.
Embossed Original- Building Dept./Applic'int Copy - Applicant/Receipt Coipy'-AAccounting
RECORDING REQUESTED BY
.CHICAGO TITLE COMPANY
,,-—AND WHEN RECORDED MAIL TO
(--FRANCISCO LEMUS HORTA.& MARTHA?
HORTA GUARDADO
P.O. BOX 1529
COACHELLA, CALIFORNIA 92236
QOp�
L
Escrow No. 7741224 - F32
Order No. 7741224 - SPACE ABOVE THIS UNE FOR RECORDER'S USE
CTC #7204057-K10
Assessor's Parcel No:
773-082-015-7
THE UNDERSIGNED GRANTOR(S),DECIARE(S)
DOCUMENTARY TRANSFER TAXIS $24.20
ED unincorporated area Q City of LA QUINTA
X❑ computed on the full value of the interest or property conveyed, or is
❑ computed on the full value less the value of liens -or encumbrances remaining at'time of said, and
FOR A VALUABLE CONSIDERATION, receipt of which is herebacknowled ed,
THE COACHELLA VALLEY HOUSING'COALI-TION.,• A CALIFORNIA NON=PROF T PUBLIC BENEFIT
CORPORATION
hereby GRANT(S) to
FRANCISCO LEMUS HORTA and MARTHA HORTA GUARDADOj HUSBAND AND WIFE, AS JOINT TENANTS
the following described real property in the City of LA ,QUINTA
County of RIVERSIDE ,'State of California:
LOT 3 BLOCK 67 OF,UNIT 6 OF SANTA CARMELI,TA AT VALE LA QUINTA AS SHOWN BY MAP RECORDED
IN BOOK 18, PAGE 67 OF MAPS, RIVERSIDE COUNTY RECORDS.
Dated December 11, 1997
A
STATEOF CALIFORNIA CORE
COUNTYOF RIVERSIDE )
On DECEMBER )-a, 1997 before.m'e, BY:
PHYLLIS M. MUNSEY.
a Notary Public in and for said County and State, personally appeared
JOHN F. MEALEY
personally known to me (or proved to "me on the basis of satisfactory
evidence) to be the person(s) whose names) is/are subscribed'to the
within instrument and acknowledged to me that he/she/they executed the
same in his/her/their authorized capacity(ies), -and, that by' ,his/her/th'eir
signature(s) on the instrument the peeson(s), or the entity upon behalfi.of
which the person(s) acted, executed the instrument.
VALLEY HOUSING COALITION
•ON-?RQFIT.PUBLIC BENEFIT
ON
�iiu���nu�utn111unn111n18nnnff 1:
PHYWS M. MUNSEY
Comm.#1067900 Z
R+ 'Notary Public-Caldomia 9
Riverside County
z My Commission Expires,
August 6, 19
WITNES hand andowfficialseal. ����ir����rr�itsuun� Iloilo III
9 r )77-
§bnature
of Notary l VDate My Commission Expires FOR NOTARY SEAL OR STAMP
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING UNE: 'IF NO PARTY SO SHOWN, MAIL AS DIRECTED ABOVE
SAME AS ABOVE
Name Street Address City, State & Zip
GDt-05/30/87bk
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tie Indu�frias, Inc.* Ail rights reserved.
Prin!ed ir�ILJSA. RV 30M 8/97.
�rt •�t�-k ���j���'4 �r",T,y�...a ��,, a �. �R '�^t� e ani k�� ! �;,��!
Cocoon Stilbflf%Cd 111SLILt 011
30 lb. bag
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
n Vahm, al
19.4
Net Coverage No Adjuslmenl I.,fi,,ws
56.7
75'F Mean
Minimum
5.5.
Cross Coverage Based on
Maximum Net
.917
Minimum Wright
TemPeratwe
I hickness
2' x 6' husses a,, 16' Centel::
coverage.
Per Square Feel
-Installed
-.
The Weight Per
To Obtain an
hrsulation
Minimum Gags
Square fool of
Bails But, ed
Insualmn
ShmdA Not Oc
$quare Feel
net, !it Per
Installed
Snume FOCI
Prr I,ggO
IlrsisLulre (n) nl;
Lens s lhzn:
1'er Batt
1.0011 Aqumn I rrl
In::nl q'nn
Prr ll.ig
Srin.m:lrrl
(nchr.::) _
;tlouddaNnI
l bn: Ilhs l
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
`13-24
6.5
42.7
23.4
.703
46.4
21.6
R-22
5.9
46,6'F
21.:5
.644
.51.6
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
931
10.7,
322
102.8
9.7'
Sidewalls lo'ressure lilleciglensity 2.0'PPCF1
R-13 (2 x 4)
3.551.4
19.4
.583
56.7
17.6
R-20 (2 x 6)
5.5.
32.7.
30.6
.917
36.1
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