9709-121 (SFD)'A r LICENSED CONTRACTOR DECLARATION 1
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
CV ifw' 12./31/9'7
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 exempt under Section B&P.C. for.,t: is reason
i..
Date ";;"Signature of Owner` .m
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and Ell 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
S6cfion 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 y) / { ppc y�{NCE Policy No. �jq
(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
Cobject to the workers' compensation provisions of Section 3700 of.the Labor
ode, I shall forthwith comply with tbose.:provisions.
Date ,'`_'-/?., b ,. Applicant .r,�`
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
rt4e above-mentioned property for inspection purposes. J
Signature (Owne'r/Agent)
BUILDING PERMIT PERMIT# CONTROL #`
DATE VALUATION %XiI.. 3.?)Q3. LOT }') TRACT L�? . ,6))!' '
JOB SI �'.: ��it�.!�.�i� {�I.;�:
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER ENGINEER
JOSE r1AppiAS
OWNER /BU+LDER Willi CVipC
� J'jU Stttil>t I..iV 3i Rb
67t 1 %x.,44RGf^. G,
C' A, 9 227 4
INCilO CA. 92201
(76()1147-3157
USE OF PERMIT
tih't.)
31'fJ- PE.E2MIT L)CA-.3 140T fNC.LUDE, .M -C X YA/.iVIS vitt iCN :ri rL PLAN
C FllA:X PIOR1110N OF FFFS 1111 IEJ) 7M% FOR iUft.ry,'Tl,I"ix iS'tti fA'P4cFj,, o '
SARAE PLAN' TYPE
L��S�.t'iC 4..�0143TRUE�,ON R.,eGJ$-.w.:.;•
9'4:tiCt�f�4'S.'1;I°I+:) l�f';:.t)t) �t{•
C�A,IiAC:I)rK::A.ILibt:yK'3' �L'4i.t10 �ii�'
�;
%
q� ��{ @�, �'q` /`�
diln9.6 Kb4'QA'S,�•RL1D C�l4.AR N.l�LLj' \�'AOl'4e".9.Y4CJ\y9.8K'�
MIX
'.9l
P&RMIT FEESUlaINIMlY
CONSTRUC:T10N_F-FE It)i-<NJ -411iX- Mf $554.0
PLAN f � i -t? 53
FJXC"t JU..C;.AI. VC2 101 -00(b -4..22-4w1) $ f 1 tt.09
1-.11 f IMt INO PH1:"s !U).-C>iD�iMi1i J -i I 5121.`NJ
STP1.ON0 n/tclTION 1-F- . - to I4)(V),!?44t-(n
10)
Q
hG !JA, i.'l%d•'i1`Ul� '�fa.%^\%�9LI .1+xw
Ff4F kA.S'!RUt'1 1A.E; FEE 22,5 -OW -44:33-3 42
P-R.E-CISE PLAN 101-000-441-345 0
a
'
h
S4_f4;4=aZ Yl'A!. (''MVS 1 Id`f.it:"f Ii N AND PLAN ill a:,K
$2.'7Z"3 93
LESS 11" E-P.AID IFF, S
$0.00'
TOTAt. PER MIT FIEFS 0411 K NOW
$2,773.83
RECEIPT
DATE
BWi
DATE FINALED
INSPECTOR
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
0. K. to Wrap
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
D II - Int. Lath S(
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steet>
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPRO ALS
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 3 L
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)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 9/26/97
Desert Sands Unified School District
82=879 Highway 111
..Indio, CA 92201
619-775=3500
CERTIFICATE OF COMPLIANCE
No. 16123 Jurisdiction
Owner Name Coachella Valley Housing Coalition
No. 51860 street. Avenida Ramirez
city La Quinta zip 92253
APN # 773-181-006
La Quinta
Permit #
Log #
Study. Area
Tract # Lot # 19 Square Footage 1259
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 i dditioris;under'500`sq>iare feet, detached accessory structures or replacement mobilehomes.
It has been determined the above-named owner is ekempt from paying school fees at this time due to the following
reason:
EXEMPTIONNOT APPLICABLE
This certifies that school facility fees imposed -pursuant to Government Code 53080 in the amount of
1.84 X 1,259_"--'. or $ 2,316.56 - the,property;listed above and that building
permits and/or Certificates of Occupancy for thisrsquare'footage in this'proposed probe `may novo 6, issued
Fees Paid'By pc/Bank of ,merica/CV Housing Coalition Teieph�ne :347-3157
Name on the check'•
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by - Pauline Pearson Payment'Received $2;316.56
Check No. 2006711031
Signature e7nt_
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549 STATS' 1998) this wdlserve to noldy;you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the dale on which the building or installation permit for ltiis project is sssued or on which they are_paid to the Districts) or to another public entity authorized to
collect them on the District('s)(s') behalf,.whiohevei 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 Applica'n't/Receipt Copy - Accounting
Coachella Valley Housing Coalition i
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 19 BLOCK 59 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.
61,;z 9�e(•
Date ose A. Tamias
r
RESIDENCE ADDRESS: 1 1
INSTALLED BY,n�,�� T,��
THIS ATTIC HAS BEEN INSULATED TO: YJ'771
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 $0%. recycled
materials. Cocoon is scientifically formulated in conformance with the coverage chart recom�menda-
to deliver greater efficiency per inch than other tions on the ophositc side of this card using L/ !7hags
insulation materials.
to covcr),q, ft. to obtain an R -value ofA�
R -value is a measure of resistance to heat flow — the
higher the R -value, the grcatcr the insulating power
If you would like to add more insulation to your
LNTALL S AUTHORIZED SIGNATURE DTE,
home, contact your Cocoon authorized dealer.
: r
0.
f.:
r u�
L • �� a�. a ct `„
�i •
0.e
•b .
h
J
:.S
.� 4Yt
�ifXAS�� � P:'%1''art + P TI•li y ro/ �1 i" �f bb� Y rtl �r ! Ft .•. .} } ,
1 .r � ��,�°(7� � ,� t`� 1,�, 'iS+'r<�p Oaf � P , �'L �7< `i d�j.7 � . t �I� )' ��' � 3 ) r• ? � .�� s 7i
�!�' `Ri?^="•y-, r j , �'• �.' tri , .I�t .�,I 1 / , � ,r 1 *'t �''. 11 {.�� .. � 1
{r'
..y ;,�':r'!'"` C, W001I SC:1�)I�I%CC� �I1tiU�;ll1011
�$
30 H). hag
.Uluu((avunvl Ih•:
GREENSTONEN "
+ 1001\I+N-PACIFIC COMPANY
N0'1'1:: This cuea•rlµr Alan en ... I- :des 6., .vulil�q
and is Inr cmium iol), pal lrlsrs nil)'. surd B-ralue i.
provided I'v insedli.Ig if., required it dla•r od haµ.
ler IINNI sll, It. ;it a ulinilmnp ina:dlod ILirknc..,
hwallalinn Id dK• mpliml 1 1N•r .4 6.1µv nla)' %ilial
TIN II\' 111:111 IIK' .vl Mt'11h51111111111111111111k'k1 K'T\ ;IIM1111111il IIIII II
a vi)thl per sq. It. A. n:d c -v ;, tr vill I.- inlhe•urr.I
by jl .h rondilinns :nl.l applir:ui.m Irrliliiyurs and
1 nay r:u'y ... nun.h a. Iln„ aril L. nn 02µ02l ir:n111v
a1'lu linµ IlIc mawd It-vahw. Failur.• I.I' It... in..I:dlrr 1,,
provide m least the rrquin•d nuudK of bag, per
I(NNI sq. Fl. anal m lead the winiuunn Illirknrss may
ra•sull in a leaver insl:dlyd N -slur. a:nnq,a,*Iin . n1.1v
IKrur ahninµ hwallmio ., A l v Ib 111, rrgnid.gt un nv
Ilcul 11w .u;nrd number .I bags 1..-ulnaiu Ill..
minimum msudl,d Ulirk ucss.
yl
`r GreenSlone and Cocoon arc lindemalks Ill
GloenStona, a Louisiana-Pacilic conepany.. a) 1997
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
I4Value al
MI Coves10e No Adiusluuva to. I smz
5 15.7
75'1 Mean
Miaimunl
5.5
1}urs Grvalanc Ilncd nu
I'Im I Nel
.917
Mnunnuu wniohl
lempelatule
Thickness
2' , I. hus.c: on IG' Cl:nlels
l•.mr.I,Igr.
I'm Sno.uc I and
I"Slatled
the weiyhl I'eI
In Ohlam an
Insukniml
m"IS
Snu.un I nnl nl
Ikuls IIe.Iuned
hlsulatin..
Shnukl Nnl lir.
Slluaie Ier.1
Ileouued I'nI
Ima,dk•d
I;nu.......
I'e. I INu)
Itesitilalu:n llil nt:
Tess Il.ul:
Pe, IWI
1,11110 Sy'...! I, -I
Inuil:ilnm
1'e1141!I
Squ.a�: Leel
(im:he:l
!j 1.1 Ihil Ile
.
I sti ❑6111, (Ihsl
1.464
11-50
13.5
20.5
48.8
21.3
46.9
R-42
11.4
24.4
41.0
1.230
25.15
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
MI,`
34.0
20.4
R-30
8.1
34.2
29.3
.878
36.5
27.4
R-24
G.5
42.7
23.4
.70:1 '•
46.4
21.16
R-22
5.9
415.6
21.5
.15.14
51.0
19.15
11-19
5.1
53.9
18.5
.5GG
59.5
115.8
R-13
3.5
78.8
12.7
.3111
87.0
11.5
" R-11
3.0
93.1
10.7
.322.
102.8
9.7
..breonSlnne Induslnes• Inc. Alb rights Ieserved. -
Printed in USA. FIV 30M 8191. Side-walls (plessule lilled-density 2.0 PPCF)
8:97-1T/G-A
n-13 (2 x 4)
3.5
51.419.4
.571;1
5 15.7
17.15
R-20 (2 x G) ,
5.5
32.7
30.G
.917
315.1
27.7
On