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9806-051 (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 CV1-fC Date Signature of Contractor OWNER -BUILDER DECLARATION 12/31.198 I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: () 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, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). (Tam exempt under Section, B&P.C. or this reason ,Date 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. ( ) Fhave 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. TRUCK i.N.S•iJ1;:F1 NCE 1 , A'2107 4370 00 96 (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 forthwith comply with those provisions. vl7ate: 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 pursuarit 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. j 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 inspection purposes. � e VSignature (Owner/Agent) Date n 1 BUILDINGPERMIT PERMIT# r: CONTROL# . DATE VALUATION LOT , 980&051 TRACT. 71�� t".1 .' n'. X76,598.$0 12 66+, Uri ® JOB SIE I APN ADDRESS 51-495 AVENIDA HAM1lifs'"Z 773-082-024 OWNER CONTRACTOR / DESIGNER / ENGINEER GUSTAVO CHACON TkP1A OVvrNER / BUILDER WITH CVHC ,2600 FRED 4vA.R.ING DR (#3407 45701 MONROE SM STE G PALM DESERT CA 92260 INDIO CA 92201 1760)347-3157 CB.L0, USE OF PERMIT ,S D (Ot21.50R) - PERMIT DOES NOT INCLUDE R -I OCK WALLS OR POOL. PIAN CHECK PORTION OF MES REDUCED 7594 FOR MULTIPLE ISSUANCE OF SAIVIF PIAN TY'P'E. TRACT CONSTRUCTION 1.215.00 SF PORM'PAT10 23.00 SF GARAGFICARPORT 455,00 SF 5 F-1, WOOD FENCE 200.00 LF EX1'1~( MATED COST O.0 CONSTRUCTION 76,9919.40 PERMIT FEE SUMMARY CONSTRUCTION FEE 101-000418-000 ts36.00 PLAN G`HEC' %PEE 101-000-439-318 $115.82 NIECHAtdICAL FEE 101=000-421-000 $53.50 ELECTRICAL FEE 10.1-000 420-000 ' $121.13 PLUMB N0 FEE 101-000-419-000 $145.50 STRONG MOTION FEE - RESID 101-000-241-000 $7.69 GRADING FEE 101-000-423-000 $20.00 INFRASTRUC1'LW FEE, 225.000-443-341 . S1.685.08 PRECISE PLAN 101-000,441-345 S2S.00 St)13=IX7'I!1L GO`NS!£tUC'110N AND PLAN CHECK(� f' ' JUN 1 1998: LESS .PRE -PAID FEES S01.00 , -- -1 OTA% PFRMIT rt',E9 D'[rE INOIN" S-2,709.72 , RECEIPT DATE BY DATE FINALED INSPECTOR s: a INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade 0 Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap _(c � — Q F.A.U. Framing - 3-a - 9 Compressor Insulation 3 - q Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - 3( Drywall - Int. Lath - - Final j���� �• BLOCKWALL APPROVALS Final 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 APPROVALSA Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out t Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final - 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 t Final Utility Notice (Perm) G /•cf�T 9 S T COMMENTS: Desert Sands Unified School •District 47=950 Dune'Palms 'Road Notice: La Quinta, CA. 92253 Document Cannot Be Duplicated 7607'771-851-5 CERTIFICATE OF COMPLIANCE Date 6/16/98 APN # 773-082-024 No. 17182 Jurisdiction La Quinta Owner NameCoachella Valley Housing Coalition Permit # No. 51-495 Street Avenida Ramirez city La Quinta = zip 92253 Tract # Lot # Square Footage Type of Development Single Family Residence. Comments 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 tlis time due to the following reason: a 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 niav 1uw. be --issued Fees Paid By Cashier Check/B of A/David Brudvik Te!Pptione 347'3157 Name on the check` By Dr. Doris Wilson . Superintendent - Fee collected /exempted by Juanita Green Payment Received $2,344.95 Check No. 2009914990 Signature F ICE: Pursuant at Ass bly Bill 3081 (CHAP 549, STATS.1996) this will serve to notifyyou that the'90-day approval period in which you may protest the fees or other payment identfied ve will begin to run from the date on which the buildirig or installation permit for this project is,sssued or on which they are paid to the,Distriet(s) or to another public entity authorized to d 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 fo'r ail waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting F Coachella Valley Housing- Coalition Plaza 1, 4S-701 Monroe Street,. Suite*'G' jndio, CA;92201 TEL:( 60) 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 com.pletion,.waiver, of liens and/o;r ; 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 12 OF BLOCK 67 OF UNIT 6 OF SANTA CARMELITA AT VALE LA QUINTA, AS SHOWN BY• MAPRECORDED±:IN BOOK 18, PAGE 67 OF MAPS, RIVERSIDE CO-UNTY RECORDS. Date GUSTAVO`CHACON TAPIA TM WSJ J ca 6 THIS ATTIC HAS BEEN INSULATED T0: 777 J « -10 9 This attic has been insulated to the R -value indicated above, with Cocoon'; the high -efficiency insulation. Made from 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 dealer. RESIDENCE DDRESS: 4-- s) Aa, s, INSTALLED BY: BUILDER: CERTIFICATION: S' This is to certify that attic insulation has been installed in conformance with the coverage chart recoZm/�menda- tions on the opposite side of this card using 7� bags to cover 106sq. ft. to obtain an R -value of 3y INST LLER AUTHORIZED SIGNATURE DATE a "A 40( ZIN TM I Cocoon Stabilized Insulation E 30 lb. bag i f Manufactured By: GREENSTONE::'" ATOMIZED PNEUMATIC APPLICATION , A LOUISIANA-PACIFIC COMPANY R -Value at Net Coverage No Adjustment for Trusses NOTE This coverage chart compensates for settling ^ and is for estimating purposes only. Stated R -value is Gross Coverage Based on provided by installing the required number of bags 30.6 per 1000 sq. ft. at a minimum installed thickness. Temperature Installation of the required number of bags may yield 2' x 6' Trusses on 16' Centeto rs more than the specified minimum thickness 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 Installed affecting the stated R -value. Failure of the installer to r The Weight Per provide at least the required number of bags per To Obtain an 1000 sq. ft. and at least the minimum thickness may I ` result in a lower installed R -value. Compaction may -� r, occur during installations above R-30, requiring more Bags Required than the stated number of bags to obtain the - minimum installed thickness. rt1 Installed Square Feet Per 1,000 GreenStone and Cocoon are trademarks of Less Than: Per Bag GreenStone, a Louisiana-Pacific company. © 1997 ATOMIZED PNEUMATIC APPLICATION , COVERAGE CHART R -Value at Net Coverage No Adjustment for Trusses 751 Mean Minimum Gross Coverage Based on Maximum Net 30.6 Minimum Weight Temperature Thickness 2' x 6' Trusses on 16' Centeto rs Coverage Per Square Foot Installed The Weight Per To Obtain an Insulation Minimum Bags 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 Bap Square Feet (inches) Should Not Be - Less Than: (lbs.) 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 -7/G -A R-13 (2 x 4) 3.5 51.4 19.4 .583 56.7 17.6 R-20 t � r®o (2 x 6) 5.5 32.7 30.6 .917 36.1 27.7 t � r®o