9901-038 (SFD)-LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perfury'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 ,
CV14C
ate ��ignature of Contracto
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 & Prof essionals'Code). .
( ) I, as owner'of the property, am exclusio 'I '`contracting with licensed s'
contractors to construct the p'roje'ct (Sec. 7044, Business &,. Professionals '
Code).
O I am exempt under SectionB&P.C. for this reason
Date Signature of Owner
71
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty,, of perjury one of, the following declarations:,''
O I have acid will maintain•aicertificate 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.
(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 provi ions of. Section 3700 of the Labor
Cdde, l shall f rthwith comply with thos r • visions.
ate: / Applicant .
Warning: F ilure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in,Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made, to the Director of Building and Safety,
for'a permit subject to the conditions�'and restrictions set fortti on` his .,
application. s
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold -harmless the City of La QuintaJts officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance -of such
' permit, or.cessation of work for 180 days will subject permit to cancellation.
I certify that, I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to•enter upon
the above-mentioned propertyfor i pispection purposes. v'
g Lure (Owner/Agent) Date
'BUILDING PERMIT, x• PERMIT#
901,;.0A.y
DATE VALUATION LOT TRACT
U e
SITE
ADDRESS 5)2.360i4.V.ENiI DA. R .Mi1R.�.
APN 773.262.066OB
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IIL'RO RRA SAI vrC.fi r Z
0ce raq.TER / 113 r1T) EIR. 711VI
W
d 49615'1 'ArY nn SP 50 .
45101 k'Homm, Tr mt o
CCJACFR1wLLA CA, 922Yi
INDIO C.A. 922201
f
f lEt) �c.4?-31.7 CRIN
OF PERMIT
�,11ivO i», P}11'vlil. Y DWELLING
Sl a f -+.t iSiil 1 +`u;i`sSI(1`-3 MUME t�Lfiiii WALL OR 1%i�iL.
- Y.
fotvloUS f>'wCN1IT 15 m,- ATZK,51.�(98,07• 1ZTi-(_e 'FD Oec-M T<itjt,�lac:
1`i a431.s1cED VW TOY> 'F'l cc m i ;
1 • Vit,
i'&.itCRPATIO 106,00 SP
Cit'tilt.AtGWC;AECPOKr 326.00 SF
' .bJ� ��.pigkEA`A AUkt i.:Vw`$.Y,'V! W..i.pN 1 a+
77,640,70
Ct�N31IRElC'i ION "HE 101-000-4.18-000
11 EX,TI eNIC:1 L141#3
f L:iC"i2tt,11L.1 t1: I01-0t3U 420�iit+3 S11G,S�
Pl.ftfLi3l�iti t 6if* 101-000-419,000
�•t'fi(}�C3 iV�iSi'i(11.�1'�C' [1Hy9'f) i{„it,..ii(� ��ll-iD�1?} ��,"'f'.
%IRA M F, ion (► a h og $ati.f»
'`
1l14Er1W'A REX,..1"t lftl: FEri:. `??3,5-�`t4f?-443.3st.7
P RECI;S.E ,k":i AX ! ()14)00441 :34:5 „" $25.00
SUB -TOTAL, C.'r0N,5- .'.! 1,TC {.t0N AND PLANI CHRM
S3,04430
.
1*01'A.B, kER Ct F, U.'
044.:30
RECEIPT
DATE/1
BY
'���
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
_log ox
Ducts
Slab Grade
tT7
Return Air
Steel
Combustion Air
Roof Deck
_Y
Exhaust Fans
O.K to Wrap
/ —Q
F.A.U.
Framing
-y
Compressor
Insulations
I
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath—
Drywall - Int. Lath
2 3 7 -
s
-2
Final
Final o wleer
BLOCKWALL AP ROVALS
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 APPROVALSn
Gas Test
Electric Final
Waste Lines
Z- - gr
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) lot r -S Ile It 57
ELECTRICAL APPROVA
Temp. Power Pole Z
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) ZZ
COMMENTS:
�vp�►�a�ao �
Building J3i o l
Address l0 rl vc.
Owner
f4 i LG Vl i ® %A 1 -2-
Mailing Mailing ll
Address L1 q41-1, T 1 W
City, Zip
C� c.[� X1223
Contractor
Out; fjcce Glu t c
T41y. a 4 "
P.O. BOX 1504
78-495 CALLE TAMPICO
*11e -2—LAQUINTA,.CALIFORNIA92253
Zip I Tel..
State Lic.I City
& Classif. Lic. #
u
Designer � fn'L S' - S � d1
Address Tel.
7?8
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from. the Contractors License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to Its issuance also
requires the. applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code. or thathe is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031,5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
(A I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
doesnot apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i i 1 am exempt under Sec. B. & P.C. for this reason
Date 4 p wrier
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.' Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and Is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building -
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
WHITE =FINANCE YELLOW =
t
APPLICATION ONLY
.DING: TYPE'CO-7NST. OCC. GRP.
Number
J Description
,ct Description I!► "f 'r�icM t �`[ ���1'(�✓19
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setbacit from Center Line
Side Setback from Droperty Line
FINAL DATE INSPECTOR
O
Issued by: Date Permit
Validated by:
Val
PINK = BUILDING DIVISION
e
S ie t i s Stories
% Units /
New Add ❑ Alter ❑
Repair ❑ Demolition ❑
r
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setbacit from Center Line
Side Setback from Droperty Line
FINAL DATE INSPECTOR
O
Issued by: Date Permit
Validated by:
Val
PINK = BUILDING DIVISION
e
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE'
Date 7/31/98 APN # '773-262-006
No. 17424 Jurisdiction La Quinta
ti
Owner NameCoachella Valley Housing. Coalition Permit #
No. 52-360 Street Avenida Ramirez Lcg #
City La Quinta Zip 92253, Study A: -ea
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 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
1.93 X 1,302 or $ 2,512.86 the property listed above and .thar-Dbildin `_
permits and/or Certificates of Occupancy for this square footage in this proposed project i�iay.now'be issued f
Fees Paid By CC/Bank of America/David Brudvik Telephone ,` 47-21;157 w
Name on the check. r. rY
Fla n-.
By Dr. Doris Wilson
Superintendent { \
Fee collected /exempted by Juanita Green Payment Received $2,512.86
Check No. 200991626
Signature (Ia,� �_ A( �'
NOTICE: Pursuant of Ass.&mbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protea the fees or other payment identified
above will begin to run from the dale 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 wavers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting 1
Coachella Valley Housing Coalition
Plaza 1, 45-70f 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 AND BLOCK 82 OF UNIT 10 OF SANTA CARMELITA AT VALE
LA QUI NTA AS SHOWN BY MAP RECORDED IN BOOK 18, !PAGE. 70
OF MAPS, RIVERSIDE. COUNTY, CALIFORNIA.
Date
i
. / J
xllax �,
HILARIO RUIZ RPWIREZ
• � _ •y- .-t.. _ ��.. yam.--..-�.•--+' - �-�.r�-_ � _ .3 .� _ -�
C V H C
MEMORANDUM '
TO: La Quinta Building Department '
FROM: David Brudvik + ,
SUBJECT: Owner Changes, Sq. Ft. Changes -Group 9,
DATE: December 16, 1998'
• Reynaldo Valadez Gil- 52-360 Ave. Ramirez and Jesus Camacho•Lopez- 52-340 Ave. Ramirez
have dropped out of the program. The new owners are:
Hilario Ruiz Ramirez 52-360 Ave Ramirez, s
Alejandro Cardenas Carrasco 52-340 Ave. Ramirez.
Both houses will change from 1300 sq.ft. to 1215 sq.ft.
Colors, set backs and elevations will remain the same.
3
i
4
STRUCTURAL ENGINEERING CONSULTANT
54625 AVENIDA BERMUDAS. LA QUINTA CALIFORNIA 92253 t;
760.564.0884 PHONE s 760.771.3606FAX! WISH CWIA.COM
June 24, 1998
Mr. Daniel Crawford - Inspector
City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, California 92253
Regarding: CVHC Plan 320 and 420 - Truss Calculations — Group 9 (Typical aU La Quinta Projects;
Dear Daniel:
I have reviewed the truss calculations from Imperial Roof Truss which is to be used for the roof constru:tion of the 3 bedroom and 4
bedroom homes in La Quinta. The truss calculations labeled "320 Plan" are for the 3 bedroom plan that is associated to the "96-051
job number listed in the lower right comer of the architectural plans. The "420 Plan" truss calculations correspond to the "96-052" 4
bedroom drawings.
I have reviewed the truss calculations to confirm the capacity of all design loads drags and bottom chord loaded girder trusses. I have
found each to be in compliance with the intentions of the structural design. I have also verified that the roof dead loads used in the
design of the trusses exceed the design loads on the structural calculations. The truss calculations are more conservative and therefore
acceptable.
The Truss calculations will be used the self-help La Quinta Project - Groups 4, 5, 6, 7, 8 and 9. Each group will use the same plans as
those mentioned above that these truss calculations conform to. I have provided a separate letter referenced above for each group.
These are intended to simply the City's records and allow a separate approval for each block of homes. Coachella Valley Housing
Coalition can provide the,addresses for each lot in each of the groups listed
Please contact meat your earliest convenience if you 'should have any questions or additional requirements.
Si rely,
ennis S. Wish PE
Structural Engineering Consultant
fit, F Lss�w
C
c-14125) m
LLJ
STRUCTURAL ENGINEERING FOR • CUSTOM HOMES • REMODEL - COMMERCIAL • LIGHT INDUSTRIAL • SEISMIC RETROFIT & REPAIR • UNREINFORCED MASONRY"- RETAINING WALLS & FouNDAnON • REPORTS:
DAMAGE ASSESSMENT - NEW ROOF • INSURANCE CLAIM • DENNIS S. WISH P.E. HAS BEEN A MEMBER OF THE STRUCTURAL ENGINEERS ASSOCIATION OF SOUTHERN CALIFORNIA SINCE 1983