9805-046 (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 # t t Lic. Class Exp. Date ryry
CV1'1t_'.
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:
(X) I, as owner of the property, or my employees with wages as their sole
X 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).
( ) J! m exempt under Section B&P.C. for this reason
vDate !% 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
ion 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.
MUCK 1NLP.WeCE ; 1140+27 4.170 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
subjectAto the workers' compensation provisions of Section 3700 of the Labor
CodeI shall forthwith comply
awith thos .povisions.
te: e\pplicant_
�� —•�
Warnin : Fail re 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 -inspection purposes.
/ignature (Owner/Agent) Date
BUILDING PERMIT a PERMIT# CONTROL#.. r
DATE VALUATION $77.640.70 LOT I I TRACT ' P-�%)�
5 4 �, l
JOB SITE :?.� '6.t ' i�.�' ENTOA tGUM,TRU
APN 773431-018
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
"'I"DRI"S n l u� r;�4 ;.1aPt�
cs���*r 1�. I StJIt.. I.l: `.`11'f"f 1 C e ,
19190 3AZ&HNN ST
45701 MOI•iWE T .' Ii'r Cr
f: JA.CHE' ,Lr1 CA 92236
INDIO CA 92201
57
(760Y147-1157
USE OF,PERMIT
SI -47 - (3 BEDROOM) PLRW !' WES NOT INCLUDE u0C:'h OR.
P(X), .. PLAN e;.'F4&,.t;. VORTION OF F'bFS REDUCED 75Y- o Fpji .� v U 'CIPLF
ee
1&4'U it.4CIE Ci SAME KAN '11 PE. e
P
f
.
TRACT CONS iRUMON 1,215.00 SF M
Y 14 1998 .
PORCf•TRIXT1t3 Ift.00 5F
GAR.AG&CA.RYIORT 524"" 41 �..,y�
a.ri 0 9
4e
F Lu`t C)U�
r
ELSTIVVIA TED COST €9F CONSTi°:IC'Tt:,R`
77,640.70
P.i;.TZI941,11' FEE SUMA1IARY
CON4TRUCTIONH1.4:4✓ 10.t-UUl)-4184if)t) ;�ti1A. iJ
ro�.ss:l� t`NEG'f. r~;?t<. IQl-(?Un 4t9 -11S $1!4,P3
tx;�I:wlcal� t id tUA-30(t ..ai'UUf)tJ.��
61.133C71M.AI. FEE t(i!-OUiI QZU-UUU $t 16.55
..`
PL1JIbt}.DCN(i FEE'101-O()0--419-00() S i3 t . it►
r • T , t
`rlit()M{Tf1Rt7't')1�tE r'Ft - ftFSlf) MJ -CM -4-41-()(U V.76
GRAfXNG I� Z AUA-Ut 0 'r U00 $20.00
INFRAS'rRLK!Ti:RE FTJ, ;, 225 G00--4i&_W W 5t.:: [6.:3q
i"ltEXA SE PLXN 101-000-4/41-345 5250)
4i
SVA-11-YrA 1., CON' Z"FRIIJC""I 10N A N, M P AN C. F WK.
I.ESS PRE -PAID FEF S
Ft)T;M., Pd+:RM:!').' PVE'ES DUE NOW
ILI C_:�
$.2,702.23.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
aw.
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 / /
Exhaust Fans
O.K to Wrap fi'f
F.A.U.
Framing —
Compressor
Insulation —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath �7_
Drywall r Int. Lath }
Final
Final .�
BLOCKWALL A PROVALS
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 — -
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
Final
Utility Notice (Perm) Q s�
COMMENTS:
_
4
M
:4
R -value is a measure of rvsistajice to heat flow — the
higher the R -value, the greater the insulating power.
1V
kP7 T ft t
If you would like to add more insulation to your
S AUTHORIZED SIGNATURE DATE
I N S�rjLE
home, contact your Cocoon authorized dealer.
t
VD; '01
07Z
result in a lo�er installed K-11
4' 'W: f
:tce
occur during installations alx
than the stated number
inininiurn instilled thickit
GreenStone and'i
GreenStrine, e Lovigif
I:,' GfeenStone Industri,
rinte in USA. RV 30
8-97-TT/G-A
Desett'Sands,,Unifled School. District
Notice: '82=879_-Highway-Highway'82=879_-Highway-114
',
Document Cannot Be Duplicated Indio, CA92201
-3500
CERTIFICATE OYCOM-PLIANCE
Date 5/13/9.9 APN # 773-131-008
No. 17022 Jurisdiction
La Quinta
Owner Name -Andres Martin Lopez Permit #
No. 551-656 StreetAvenidaRaRamirez I
Log #
City. La Quinta .Z
--, -92.2,53 Study Area
Zip
Tract # Lot #1,215
Square Footage
e No. 'f Units
Type of Developm�il rit' SihgIeTarnily-Resi6rice 0
comments
t
At the present time, the Desert',. Sands -Unified.. School. District *dm. ,not collect Jees .on garages/carports, covered
patios/walkways, residential, additions under, 500 square detache.d-`a'cc%1-61,s1s
oy structures o
r replacement mobilehomes.
Ii has be6n determined the ibove-named owner is exempt from Paymg11sch00 fees at this
time due to the following
reason:
EXEMPTIONNOTAPPLICABLE
This certifies that school'facilit .y �-f6es imposed ed purs
uantto Government-Code53080 in the'amount of
-
1.93 X 1415 of $°=2,344.95t.4.95 theroperty listed above and that building
permits and/or Certificates -of Occupancy forthis square footage in this proposedproject may. nqw_bp issued
Fees Paid By Cashier Check/Bank of Airieric;�/gillStandefer -3157
ned 347
poo
Nalme;on the check
By Dr.- Doris Wilson
SuperinterWent
c..
Y '. '. i
Fee collected /exemptid b' Juanita Green Payrn&if'Re eived
. .... Check -No. -2609014079
Signature%kGi //y.
lNOTICE: Pursuant of Asse-441y6il 1081 (CHAP 549, STATS.` 1996) this will serve tohotify you that the 90�ay approVal period in which-Od'may protest the fees or other payment identified
above will begin to run from the date on whi6hffi6:building 6r.installation perriieforji6ii Project is siiued or onwh-ich they are paid to the Distirkt(s) or to'another public entity authorized to
collect them on the District('s)(i') behalf, whic�h6vei is'barfier.l
Collector: Attach a copy of county or city,plan ch&*.:Application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant- c6py - Applicant/Receipt Copy. - Accounting.
I
I]
Coachella Valley'Housing.Coa(lition
Plaza I, 45-701 Monroe Street, Suite= G.; Indio,`CA 92201 _
TEL: (760) 347-3157 FAX: (7601.342-6466
ATTORNEY-IN-FACT AGREEMENT
Me hereby appoint COACHELLA VALLEY.HOUSING COALITION,
and/or any of its 'a`uthorized agents as my/our attorney -in fact for the
purpose of`ezecuting any notices -.of completion, waiver, of liens and/or
executing contracts with. subcontractors; and/or release of liens and/or
handling building permits relatingto 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_ 17 AND BLOCK.:54 OF UNIT 5 OF SANTA CARMELITA AT VALE
LA QUINTA, AS SHOWN BY MAP RECORDED 'IN BOOK 18, PAGE 63
OF MAPS, RIVERSIDE COUNTY RECORDS.
LI_ � _
Date
�6y � �g
Date
f:\sfamily\anna\miscf6r\a.ttnyfa
Teresa De Jesus Lopez Lere a