9806-056 (SFD)LICENSED CONTRACTOR ONTRACTOR DECLARATION
1I: 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 # Lie. Class Exp. Date
CC'VHC 12/31/98
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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
(�; I am eempt un er Section B&P.C. font is. reason'
oDate 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.
Sec( ) I have and will maintain workers' compensation insurance, as required by
tion 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.
TRU 1NSiJRANCE 1 . A2007 4370 00 96
(This section nee not�be completed If the permit valuation is or $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, Is all fo Ith comply with th a ro Islons.
s6ate: / Applicant f sm-- __
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, indemnity
& 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 f r -inspection purposes.
'Signature (Owner/Agent) /8 -' Date 12�/g
' =PERMIT# CONTROLN
BUILDING PERMIT ti
DATE VALUATION LOT �� �TRACT'' 9
.49 71 40A.70
JOB SI T
APN
ADDRESS
?� -- (11 V RAMI Y
7'1.'11..84 3. MA'
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JORGE CELLS CA.STREJON
OWNER/ BLMDER WITH CVHC
PO BOX 1528
45701 MONROE ST STE G
INDIO CA 92201
INDIO CA 92201
( 760)347-3157 C-80
USE OF PERMIT
CSR
S 121 50L) - PEWT.DOES NOT INCL UDE BLc:►CK WALLS OR POOL, i
TRACT CONSTRUCTION 1.21.5.00 Sr.
PORCH/PATtO 102.00 SF
'
GARACOCARPORT 5'26.00 SF
ESTINIXfED COST OF C01dMUCTION
77,11411.70 ;
PERAUT FEL SUMMARY
CONSTRUCTION FEE 101-000-418-100 $540.50
* ;
PLAN CHECK FEE 101-000-439-318 5456.10
MECHANICAL FFX- 101-000421-000 $40.50
,, t
F-t.EC'i RICAL F 101-000-420-000 $1.16.55
PLU1VWING FEE 101-000-419-000 S121.30
'1
STRONG MOTION FEE - RESID 101=000-241-000
GRADING FEE qw 101-000. 23-000
INFRA.S't<itilt.'1IME MT- 225-000-443•342 X1,'7_ oq
�
PMCI.SE PLAN 101=000-441-345
+u�
SUB-T011�►;L 0bNS,1AUC I10N AND PLAN CAECk
JUIN 1 8 j�'�. :, LESS PRE -PAID FEES
3.0 tft3,.• '.
1?1itki7 PERMIT FEES 33i1ENOW
$3,044.:30',
RECEIPT
DATE.
e81
DATE FINALED
INSPECTOR i
M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck ,2 —02 —C
Exhaust Fans
O.K. to Wrap —Q -- Q
F.A.U.
FramingCompressor
-
Insulation C —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 3-2
D 1wall - Int. Lath — — IE
_
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 / C
Utility Notice
(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
IkExterior Receptacles
LG.F.I.
5Smoke Detectors
JkTemp. Use of Power
Final
t2lUty Notice
(Perm) ��
n -a.,,.-.: r,..�•-=�v :.v«..,y,.,r .� �...-s'+/8r'w�"� •wa ' a:rA+'r'(�r;�..qF,�?ti''`"`'����•py"'=�.-"a•L+"�,,K%`:�».�, ,..:y. �.....�,w,w•,-.--rte.,,•-;.�5_,;rE;��:�
• .'11r�1�7 V�
P.O. BOX 1504 APPLICATION ONLY
Building 78-495 CALLE TAMPICO
Address St'3�o AvgIwi�� LAQUINTA, CALIFORNIA 92253
2MX410
Mailing (�
Address
City Zip Tel.
JAI 010 1220) 3(4'7-Aq-7/
Contractor t�
OWit1/� /7 4ii-D*
Address
City IZip . ITel..
State Lic. I City
& Classif., Lic. #
Arch., Engr.,
Designer
'Address Tel.
CityI Zip I State
tf Lic. N
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.
.JIGNATURE 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, after, improve, demolish, orrepair 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, 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
orimprovement 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 or sale.)
I'I 1, 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 J 1 am exempt under Sec. B. & P.C. for this reason ``II,���^-yyamJ
Date' Owner A VWAIC—W.
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. ❑ 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 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, alter 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 sof this city to eriter the above•
;'mentioned property for inspection purposes. '
Signature of applicant - -- .. Date
Mailing Address
City, State, Zip
WHITE = FINANCE
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number -7 -73 � o s 3 — 00&
Description U
t Description .E R �`5i NC E
Sq. Ft. J �/5- No. ! No. Dw.
Size �s Stories Units
New ter Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
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:
PINK = BUILDING DIVISION
Desert Sands=Unified School`District
47-950: Dune Palms Road
Notice: La"06inta,.CA 9225a.,
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/16/98 APN. # 773-083-006
No. 17187 'Jurisdiction La Quinta
Owner NameCoachella Valley Housing Coalition Permit #
No, 51-340 Street Avenida Ramirez Log #
City La Quinta Zip .92253 Study Area
Tract # Lot # Square Footage 1;215
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-riamed owner is exempt from .paying school feesAf 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 theproperty listed above'andYat t5uild.ing
permits and/or Certificates of Occupancy for this'square;footage in this proposed project,maya ow be issued
Fees Paid By Cashier Check/B of A/David 8rudvikTilep6ane 3'47-315?
Name on_the'check
By Dr. Doris Wilson -
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,344.95
Check No. 2009914990
Signature C�-Iao,l,�i Z4(��
NOTICE: Pursuant of Ass#bly Bill 3081 (CHAP 549,,STATS. 1996) this will serve to notify you that the 9"ay approval'period in whichyou'may protest the fees or other payment identified
above will begin to run frothe dale on which the building or installation permit for this protect is issued or on which they are paid to the Districi(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..Coalition
Plaza I, 45-701 Monroe Street, Suite:'G:; Indio, CA 92201
TEL: (760) 347-3157 FAX; (760) 342-6466
L .
•
ATTORNEY-IN-FACT AGREEMENT
I/We hereby appoint COACHELLA VALLEY HOUSIN&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 19 OF -BLOCK 66 OF UNITZ,OF SANTA CARMELITA AT VALE LA
QUINTA, AS SHOWN' BY MAP RECORD:ED,IN BOOK 18, PAGE 63 OF
MAPS, RIVERSIDE•COUNTY.RECOR`D'S.
C G'
Date
5
-41
Date
f: \sfa m i ly\a n n a\m is cfo r\attn yf a
JOR`GE CELIS CASTREJON
MANUELA:BELTRAN CELIS
'sS3r,
THIS ATTIC HAS BEEN INSULATED T0:
s.
Gam,
;mom r-:4_ '
a V"
J { ea
Ft 1>.
RESIDEN E ADDRESS: LO l�
Z- z �S;13
INSTALLED BY�������� fJ�
BUILDER:
CERTIFICATION:
This attic has been insulated to the R -value
indicated above, with Cocoon`; the high -efficiency This is to certify that attic insulation has been installed
insulation. Made from a minimum of 80% recycled
materials, Cocoon is scientifically formulated in conformance with the coverage chart recommenda-
to deliver greater efficiency per inch than other tions on the opposite side of this card using bags
insulation materials.
to cover/�6 sq. h. to obtain an R -value of
R -value is a measure of resistance to heat flow — the
higher the R -value, the greater the insulating powe . 'r
36
If
If you would like to add more insulation to your �NST�ER'S AUTHORIZED SIGNATURE ATE
home, contact your Cocoon authorized dealer.
�a
�i
.4
TM
Cocoon Stabilized Insulation
30 lb. bag
Afanufacrured By
ATOMIZED PNEUMATIC APPLICATION ,
COVERAGE CHART
R -Value at
19.4
Net Coverage No Adjustment for Trusses
56.7
751 Mean
Minimum
Gross Coverage Based on
Maximum Net
30.6
Minimum Weight
Temperature
Thickness
2' x 6' Trusses on 16' Centers
Coverage
Per Square Foot
Installed
The Weight Per
To Obtain an
Insulation
Minimum Sags
Square Foot of
Bags Required
Insulation
Should Not Be
Square Feet
Required Per
Installed
Square Feet
Per 1,000
Resistance (R) of:
Less Than:
Per Bag
1,000 Square Feet
Insulation
Per Bag
Square Feet
(inches)
Should Not Be
Less Than: (Ibs.)
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
GreenStone Industries, Inc. All rights reserved.
Printed in USA. RV 30M 8/97. Sidewalls (pressure filled -density 2.0 PPCF)
8-97-TT/G-A
GREENSTONEC•.'"
A LOUISIANA-PACIFIC COMPANY
NOTE: This coverage, art compensates for settling
and is for estimating purposes only. Stated Ii -value is
provided by installing the required number of bags
per 1000 sq. ft. at a minimum -installed thickness.
Installation of the required number of (rags may yield
more thadthe specified minimum thicltness'and minimum
.weight per sq. ft. Actual coverage will be influenced -
by job conditions and application techniques, and
may vary as much as 10% without significantly
affecting the stated R -value. Failure of the installer to
provide at least 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 above 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. Q 1997
R-1
3 (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
t' �