9805-043 (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
C VHl- 11131i9ls
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
ense 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).,
( ) l,. as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
?Code).-
� Un er Section B&P.0 r hi reason
V ate p G%s 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.
(?� 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.
Mtl k. lNS�LJ}2.t'tNCE 1 7 ,53'0 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,
.1 shall not employ.any person in any manner so as to become subject to the
workers` compensationlaws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sh it fo Fjw�h comply with tho p ov'sions.
(Date: �J `�0 Applicant .�^�"'�`
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned p rope rtyjeoYlspection purposes.
Signature (Owner/Agent) DateAA6
BUILDING PERMIT PERMIT.# 0.5-9?43 CONTROL#
J
DATE g 11 Y CJ VALUATION LOT LOT Y, TRACT
JOB SITE 51-905 A�'�,NWA .I$rLMIE�E
ADDRESS
APN 773-145-0201�
OWNER
CONTRACTOR / DESIGNER / ENGINEER
171 ')V1 171 116.11-) 4!
N
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APP OVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade / ]'—
Return Air
Steel _
Combustion Air
Roof Deck
Exhaust Fans
O.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
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL AP ROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines /t�9y-,(//
Heater Final
Water Piping T
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 !& S
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
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
l
Final
_
Utility Notice (Perm)
Desert Sands Unified! School District
Notice: 82=879 Highway 111
201
Document Cannot Be Duplicated Indio, CA ' '"
619=775=3500
CERTIFICATE OF COMPLIANCE
Date 5/13/98
No. 17019 Jurisdiction
Owner NameFlorentino & Maria Reyna
No. 51-905 Street Avenida Ramirez.
City La Quinta zip 92253
APN # 773-165-020
La "Quinta
Permit #
Log #
Study Area
Tract # Lot # Square Footage 1,302
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District doe's not collect fees' on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structure's or replacement mobilehomes.
It has been determined the above-named owner is exempt from paying school fees at 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 1,302 or $ 2,512.86 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed projectmay now be issued
Fees Paid By Cashier Check/Bank of America/Bill Standefer Teieph p'-,347=3157
. - v` r
Name on the check
BY Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received
15.?12-.,6
Check No. ' 2009914079
Signature
NOTICE: Pursuant of A mbly Bill 3081 (CHAP 549, STATS. 1996) this will serve.to riolify you that the 90 -day approval period in which you may protest the fees or other payment identified
will begin to run from thedate on which the building or installation permit for.lhis'projecl is sssued or.on which they are paid to the District(s) or to another public entity authorized to
tolled 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
Y
Coachella Valley Ho.qsfnii odation
Plaza 1, 45-701 Mon'r'oe Str"i, Suite G., Indio, CA 92201,
TEL: (760) 347-357FAX:_ (760)J42-6466
ATTORNEY-IN-FACT AGREEMENT
IMe hereby appoint COAC-HELLA.VALLEY-.HOU.SING COALITION,
and/or any of its, auth,oriz6d'q'g,entt as inytour attorney -in fact for the
purpose.bf executing any notices. of 6ornpletion', waiver, of liens and/or
executing conte -acts'. with' s u bap'ntradtors, ^and/br.re . lease 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 asJ011-6ws:
LOT 8. OF BLOCK 58 OF UNITS OF -SANTA. CARMELITA
ITA AT VALE LA
QUINTA, A.S.,S'H.OWN'BY, MAP. RECORDED IN. BOOWI 8, PAGE 63 OF
MAPS, RIVERSIDE COUNTY RECORDS.
Z,
Date I Flqreniifho'S. Reyna
Date
f:\sfami[y\anna\miscfor\aftnyfa
Maria b6na. Reyna
THIS ATTIC HAS BEEN INSULATED T0:
RESIDENCE ADDRESS: 1A 1
51905 ✓ 2 - m l rcz
INSTALLED BY:
BUILDER: C, ✓
N5701 Monro
i1
G I
This attic has been insulated to the R -value CERTIFICATION:
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 reco/mmmenda-
to deliver greater efficiency per inch than other tions on the opposite side of this card using. bags
insulation materials.
to cover 1114 sq. ft. 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 power.
If you would like to add more insulation to your STALL S AUTHORIZED SIGNATURE DATE
home, contact your Cocoon authorized dealer.
:11rrnq%rrctrmred Tic
GREENSTONEFe. "
A LOVISIANA.PACrPrC COMPANY
VOTE: This coverage chart compens:nes for settling
and is for estimating Purposes only. Started R-v:due is
provided he installing the required number of bags
per 1000 x1. ft. at a minimum installed thickness.
Installation of the required number of hags may yield
more than the specified minimum thickness and minimum
"eight per sq. ft. Actual coverage vill be influenced
hl' ioh conditions and application techniques, and
mac can' as much as IWb without significandr
affecting the stated R -value. Failure of the installer uh
provide :u least the required number of bags per
1000 Al. ft.and at least the mininuun thickness may
result in a loec'er installed R-r:due. Compaction may
occur during installations above R-30. requiring more
than the stated number of hags to obtain the
minimum installed thickness.
GreenStone and Cocoon are trademarks of
GreenStone, a Louisiana-Pacific company. (D 1997
GreenStone Industries, Inc. All rights reserved.
Printed in USA. RV 30M 8/97.
8-97-TT/G-A
Cocoon Stabilized Insulation
30 lb. bag
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
51.4
19.4
Net Coverage No Adjustment for Trusses
56.7
R -Value at
R-Value
Minimum
5.5
Gross Coverage Based on
Maximum Net
.917
Minimum Wei hl
9
27.7
Thickness
2' x 6' Trusses on 16' Centers
Temperature
Coverage
Per Square Foot
The Weight Per
Installed
Square Fool of
Bags Required
To Obtain an
Insulation
Square Feel
Minim:im Bas
g
Installed
Square Feet
Per 1.000
Insulation
Should Not Be
Per Ba g
Required Per
Insulation
Per Bag
Square Feet
Resistance (R) of:
Less Than:
1.000 Square Feet
Should Not Be
(inches)
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
R-13 (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