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9709-123 (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 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< 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!G-°°6FAhis reason Date % .9 , r ' iSignature of 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. A I have and will maintain workers' compensation insurance, as required by SAction 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. iRUC.1r%.-±.AMRniJt;X i r'i:;+A 7 43 0 00 (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 to10workers' compensation provisions of Section 3700 of the Labor Code, I shalb•forthwith comply with those, proviisll, S. , Date: % ie; i 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.�esult 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 for inspection purposes: :< Signature (Owner/Agentj3�°'�' 4i A- DateV":, BUILDING PERMIT PERMIT# CONTROL# .. • a8ili�;-t�:3 7 r DATE VALUATION 877J69,20 20 LOT . TRACT JOB SITE 81-00 0 A EtVilBA fi4.t'LMUREZ APN 7 3*4 11—lwi4d8 ADDRESS OWN1E?R%, CONTRACTOR / DESIGNER /ENGINEER (rryrtPe(iM1"Z N'E, 14,111, IIG.011.1DE A1,111 -a i] ytiMI i1i.11iV#i;:+� tia F Tr,6 ('A 9? 74 1INDIC) CA 9Z201 (760),147,1157 C' 4` L4 USE OF PERMIT 51,13 "s.r]- f'1t Atif l rpt_::rtiC)'I I1v'CLUL , BLE,C.K WALLS' Ctl KiOL, NAN f,11WX I-''(3tf:1` 014 0r fl-_IS i'Cl: 7IOC L) 7!)q•4• FOR Mk.TLT11:q _ 3iS-SS(V t-! NT.A2J"P'4 PI?. �.ril�,L�'�.i/A'b:o .�Lt1.:l.•!i'..*ji5 i,.�u.t4�.i�,�Fi" _ i'i.,�t2�".€'irl�riTlG A02.tIs! S� (#A1tAi9H.aCt1RP RT W.00 ISP, ES*,91 ,%1,:', £;) ..moi 04 i"_OP.STRILJ;:',"#t' O 77..4169.,20 C0NIS RUCT10N F15F, 101-0W4184)00 $5lii_S!1 PLAN FIEF. 101 e'Xt{J.-439.31.8 N1LCAU{ N.11cX1. s`LE 0.0AR40;' L Fffi 101--vW420- S i I (;, 7 VIA 4U't13fNG F'Efi 101 -00D -4194M) 16 i.. Sti ,%11T4')NONi(17''1'ON1;:f-.RF,1i,!0 103?4',,(V 101 4(,` O-.113.014;0 !It) atdHkA 3`€ Rk)C.'Rrkfi i"GE 22, 41 t'AfKA.Sh PLAN 101-4N1d9-•' 41-345 S2S.(k) St tTi='€'(:pT. _• 6':3IN$T:h?,UC110113 AND fa1,xAN l"'I [€sC"1.. �Z,�t)5•�Jt! T(T AL NIf71.1. I tl- MAN 72,os.q\1' RECEIPT DATE d BY {„ DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE I 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 /AV, 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 14 Dryvyall - Int. Lath D Final Final BLOCKWALL APPROVALS POOLS - SPAS steel, Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I 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 Lateral44 a Pool Cover Sewer Connection I 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 1.4 Utility Notice (Perm) COMMENTS: Desert Sands Unified School District Notice: 82 -879 -Highway 11.1 Indio, CA 9220'1 Document Cannot Be Duplicated 619-775=3500 CERTIFICATE OF COMPLIANCE Date 9/26/97 APN # No. 16125 Jurisdiction - 7737171-008 Owner Name Coachella Valley Housing Coalition Permit # No. 51910 street Avenida Ramirez Log # r City La Quinta zip 92253 Study Area Tract # Lot # 17 Square Footage , 1210 Type of Development Single Family Residence No. of [snits 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-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 1.84 X 1,210 or $--2,2261.40 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By oc/Bank of America/CV Housing Coalition Telepione -347-3157 Name on the check —. By Dr. Doris Wilson , Superintendent Fee collected /exempted by Pauline Pearson SignatureklU .Payment Received r_ $2,226.40 Check No. 2006711031 40TICE: Pursuant of Assembly.Bill 3081 (CHAP 549, STATS. 1996) this'will'ser4e to notify you th'at'the 90 -day approval, period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(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 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 17 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. 9 171d tof Date Hector E. Gomez �- 3 2'2� 00 rpa Date Maria Isabel Gomez THIS ATTIC HAS BEEN INSULATED TO: RIM This attic has been insulated to the R -value indicated above. with Cocoon-, the high-cfficiency insulation. Made front 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 Ilea flow — the higher the R -value, the greater the Insulating power. If You would like to add more insulation to y(jur home, contact your Cocoon authorized dealer. I RESIDENCE ADDRESS: INSTALLED BY: f7o 4 olfanc6er--Unz:�4 j BUILDER: ti C E R TI F I C AT 10 N: This is to certify that attic inSUlation has been installed in conformance with the coverage chart reconimenda- tions on tile opposite side of this card using bags; to cove t. to obtain an 11 -value of 7 IN TALLE AUTHORIZED SIGNATURE QJTE TM .IGoerf Ia In"VI l71r GREENSTONEpe. Y • IOYI{1AM{��•elrlt COYe•M• NO'1T4: Thi, ru.•a•ra);c than ar nnlx•ns:ur. lin ..•olid). and is lin' caincning purlxaa•.. null'. simed u.-IYr i, pnlvided by insedling Ihr ravpliu•d ... nl ba,t. par Ilrxl ml. 11. m a ulinimmn in.edled dlirknr... hpa:dl:ei.nl .d dn• rnplilael nuud••r .d Wg nal)' �'k•IJ nlalm Ih:m dx•.Ixvilrrd ..linin uun Ihk'klx•.m m.I minimum ,,vighl I"•r sq. It. Anus) i•urrral;r .vill la• inthi'urrd by j..b .nndiliuns :....I algdiraliun Irrbniqu.... .lud m:y vary .1.. ...urh .1.. llr::. .cidlnm .illuilir.unly Ale'linµ Ihr .soled R-vahu•. Failnrc nl Ihr in.lallrr I., provide m learn the rrgnir d nnnlber .d lmg, I... 11a N) ml. II. and at least the minimum Ihirknr.. mal' «•.uh in a In.vrr insl:dh•J It -valor, I:nmp.na i.... dl... I x'rur dnring inslallminns a -ve II :NI. avp.6iol; nu nv thm. ahe salad nunlhrr ..I ba);s I.. .Amin Ihr uliniuuun insadlcd Ihirkne.s. GroenSlone and Cocoon are Nndomarks nl 0.i Greensione, a Louisiana-Pacific company. © 1997 GroenSlone Indusuies, Inc. All ii8hls resolved. Printed in USA. RV 30M 8(97. Sidewnlls (pressure lilind-densily 2.0 PPCF) (;(1'C(x>Il Stahili CILI lnSLI136(n30 Ih. had; ATOMIZED PNEUMATIC APPLICATION COVERAGE CHART 0-vahm al Net Comage NY Adjuslmmol Int Ilases ]SI McaMinimnln Gross Civ.%melempemlYle lhickness Mnrinnlm Net Mnuuuun Weigh) 2' e 17 Imses ii 16' ('.elder.c-mage. I'm Snu:ue Iml Installed Ihe. Weight I'e, In Ohl•m an InsulalimMms Itv-powd InSWAii.1 Shmdd Nil Be swore feel 11npinrA 1'el InSLdhal StI'pcue. I.." 1Y. 1010 Ih:sisl cte) nl: Less ll.au: II,,,, llall Ipme. lcul sni)squale. leel Slendd Nul Ile.Ikl.t (11e; I 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.G 32.0 31.2 X137 34.0 29.411-30 8.1 34.2 29.3 .878 36.5 27.4 R-24 G.5 42.7 23.4 .703 4G.4 2.1.6 R-22 5.9 46.6 21.5 G,14 51.0 19.6 R-19 5.1 53.9 18.5 .55G 59.5 1G.8 R-13 3.5 18.8 12.7 .381 87.0 11.5 R11 3.0 93.110.7 .322 102.8 9.7 8.97-TTIG-A R 13 (2 x 4) 3.5 1.4 8.97-TTIG-A R 13 (2 x 4) 3.5 1.4 m �'. i.• ']).•.' � 4.Ib '.yjyjt((ti. .'1