9712-084 (AR)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
aeVL Oignature 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).
O I am exempt under Section , B&P.C. for this reason
Date r 2 / 1) -0i 2 Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty ofperjury 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.
(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,s1iall 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those^provisions.
Date: Applicant-
Warning:
pplicant Wrning: 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 property for inspection purposes.
Signature (Owner/Agent); Date
BUILDING PERMIT PERMIT CONTROL#
7112-4084
DATE ' VALUATION *i►,�s�1 LOT TRACTGGIG
r'•
JOB SITE
ADDRESS 53-404 A l� �e1�IDA RF40',.1�ZEZ,
APN 774-0,425 008 .
OWNER
CONTRACTOR/DESIGNER/ENGINEER
E"E'Llv'I � �� �{11�'Qjj I.jp,,p.. r:t�,f ; ^;x�
Ci �'):t t: 1.13tJ:Lf f ? v
X3404 WV.NMDA H AA11U..lr
LA QUINTA ('A 021'753
USE OF PERMIT
Ai f(7IT1t v
•
d
Ent!V.jA��I.[�.il�d�r f�J'LYIIiATS VI��I.R��'ST'��IC4N�V.t.V
�� � 9, 7v
Pi- _AN fhb *_-X7K. Ffil', 10143f)'i), 439-318 $76 05
cNti Nf; ii{v t W -P i'f )w wF,, 1 i) t -1/91f�)0{ fl1 i ?,1-000 5117,00
"i2�r.��.1r�14��t.'."t1.. i�iwiti 1.1Ki-�`V+!-'i�� tiV�i � �1�•CO
-
t+f'iy1)t�t`At 1�EL 101-W4)q i1"tU�it) :x;1.37
�. t RQ1Nt, N401'1cat� VfE -1 E.81b 10*14 ]1*00-24,1-t4i't} M' 1
7;
sF,
"ID
DEC 1
1997
C#7'Y ^F -
_LA
Qui N7'A
5� •
al f it '1 )� 14 i_. � ZjE�J ➢'fti>fE "�'lG)%i Vi4'1) KAN C'' 4lFi -K-
v in m
s
pp Yy yy�� yy yp y; ���gty .��
�� \.S l,AI" 1C ,��R!"I T lef`''Es DUE �,iOVV
{ S
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_
Return Air
Steel
Combustion Air
Roof Deck
I Z,2 Ar_Exhaust
Fans
O.K. to Wrap
7 7
F.A.U.
Framing QGT7 !
/0
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 (�
7
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
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 Nbtice (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
t
Fnal
Utility Notice (Perm)
COMMENTS--
OMMENTS:Final
. ........
City 'of La Quints
X ....... .....
�'Building"U-,Safety'Division-
. .....................
P.O. -Box 1504
xF .T.rMJt..... .*,.,r #
X . .. .
78495 Calle Tampico
. . ..... ....
"La QUin,ia CA 92251
...... . ..
Building Termit'Application
and'Tracking.Sheet
.
Project Address:
V/1?41nl;vfz
Owner's Name:�A,
A:' P. Number:,
Address:
Legal Description:
City,§T, Zip:,
Contraoor. tAM
A'.- ba Lb M
Tei' hon,(
ep 124,0 .
...............................
....................
............................ ...........
......... ...... .
................ .
Address: LI
5,31
q. Z:,
Project Description: A)
lb 0
cit),Si, zip:
J�"2 2
L44 (A� 74? _1 ' a., /_ I -SS
Tel ePI10110,!�Lq., -0?
........... .
............ . ...
..............
.... ..
State Lic.#,:
City Lic. #:
AM'_ Engr.' Desig•ner:
Address:
City,-ST"Zip .
)c fi7
telephone:
..... ......................
..........................
. ..........
C onstruction, Type: Occupancy:
State. Lic.
............
. .. .....
P
roject type (circle one): New rAdd�n er Repair
'Aft Demo
Name,orcontact Person:
Sq. Ft. o
Stones.
Units
Teleph*6ne 4 of Contact Person:
Estimated Value ly
'o f Project:;
yi
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FF S
:ST FL.
2ND FL.
POR.
GAR
SAR P
WALL
ESTIMATED CONSTRUCTION
SO FT ,: S
UNITS
ROUGH PLUMB,
SO. FT. •,
YARD SPKLR SYSTEM
SO. FT Iis MOBILEHOME SVC.
BAP SINK
SO FT. g POWER OUTLET
ROOF DRAINS
jO. FT 4
DRAINAGE PIPING
SO FT .Z
DRINKING FOUNTAIN
SO ET, a
URINAL
VALUATION S
WATER PIPING
NOTE: Not to oe useo as prooeny :ax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONOISHI
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
-
=j
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B.T.0
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT, , c
BATH TUB
SO. FT. g c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SU. FT. RESID 0 t % c
SEWAGE DISPOSAL
SO.FT.GAR @ 4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE----] PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING A AIR GOND. ' SOLAR
SETBACK
GROUND PLUMBING'
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE M'
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINALS
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu, yd.
= pluti x=
-
=j
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE' ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
rnarea. �Ramum^ruweanwiItww
GARDEN WALL FINAL
Desert Sands Unified School District
Notice• 82-879 Highway 111
• Indio, CA 92201
Document Cannot Be Duplicated - Indio,
CA 922
500
CERTIFICATE OF COMPLIANCE
Date 12/19/97 APN # 774-082-008
No. 1642.2 Jurisdiction La Quinta
Owner NameFelix & Jacqueline Cadenas Permit #
No. 53-404 Street Avenida Ramirez Lcg #
City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 182
Type of Development Residential Addition
Comments
�ddition of a bedroom
No. of Units
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in tl=e amount of
0.00 X 182 or $ 0.00 the property listed above and that bailding.
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
y �� �•
Fees Paid By N/A Telephone -564-2423
Name on'the check
a
By Dr. Doris Wilson'`
Superintendent
Fee collected /exempted by Ellen Patino Exempt $0 00
Check No. N/A T
Signature '
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest he fees or other payment identified
Dove 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
Dllect them on the Districl('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
..r � r.. , +..,; ... ; _tj ,_..:r �� ♦fi�rr 1 M" btic�' � t A: � j;�.A �igjy_�,
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such,a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect iourself from possible
liability if that person applies for the proper permit in his or her name.-
Contractors
ame.
Contractors are required by law to be licensed'and bonded by the State of California and to have a, business license::;,;;
from the City or County.' They are also required 'by law to put their license number on all permits, for which they'
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract; you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family; and the wore (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licer.sed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employ`r,and you are subject
to several obligations including State and Federal income tax withholding, federal social se=urity taxes,, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are :specially serious with
respect- to worker's compensation insurance.
For more specific information about your obligations under Federal Law,, contact the Internal Revenue Service (and, if
you wish,"the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed. to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor anc. material personally.
Building permits are not required to be signed by property owners unless they are performing their own work -
personally.
Information about licensed contractors maybe obtained by contacting the Contractors' State :,icense Board in your
community or at 1020 N. Street, Sacramento, California 95814. .
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78 -05 -Calle Tampico
La Quinta, CA 92253 .
(760) 777-7012
FAX: (7 0) 777-7011
OWNER'S SIGNATURE/DATE "
PROPERTY ADDRESS
�>->iYicare of r%omniiance: Residential
(Paae I 01 '') CF -1 R
pmrr)j,s%C/ Date
oiect Title �1
5-3—,/0 Budding Permit s
olectAddress� nD�y�s ��y ZYZ3
C _ C4 Plan CnecK i Date
. TeNphone
ocurnentatlon Author 1 Field Check i Date
otUl,4cntorcement Agency use Only
3mpiiance AAethod IPacJcage. Point System or Computerl
Climate Zone
!ENERAL INFORMATION
"otal Conditioned Floor Area: �" tt2
Single Family ✓" Addition
Building Type: �. Existin Plus -Addition
:heck one or morel Multi -Family g-
=ront Orientation: North / East / South / West /All Orientations
(Input orientation in degrees and circle one.)
Vumber of Dwelling Units:. ll
:loor Construction Type: ab Raised Floor (circle one or both)
BUILDING SHELL INSULATION
Construction
,;omponent Insulation Assembly acctorvCo eTents
a al. etc.)
rype R -Value U -Value
Wall ..............
Wall. Ger,' rfJlr
Root ............. T pr
Root .............
Floor .............
Floor..............
Slab Edge ....
FENESTRATION
Fenestration
Orientation
Area
(st)
Fenestration
U -value
Front..... ( )
Front..:.. ( )
Left ....... ( )
Left ....... ( )
Rear ..... ( )
Rear .....
Right..... ( )
r.
u
.77
Right.....1 )
•-••4 z�
t� r:,()
Skylight .......
$
Skylight .......
9
THERMAL MASS
Type/Covering .Area
(slab/exoosed. tile, etc.)
TILE aR L11i6,_
A%4wd January 1992
Shading Devices
interior Extenor
(roller blind etc.) (shadescreen, etc.)
2o�LEj� C3( -/Nb
Thickness
on.
Overhang
ves/no
Framing Type
metaVwoc d/vinyl)
,i Tl n
•-••4 z�
t� r:,()
-may
$
0
9
1. For amen pas storage (rated input S 75.000 13wmr), sieetrie resistance and hest pwnp water heaters, list Enemy Factor.
For large pas storage water heaters Iraoad input 2 75,000 etu/hr). Inst Hated Input, Recovery Efficiency and Standby Loss.
For instantaneous gas water heaters, list Rated Input and Recovery Efficiency.
SPECIAL FEATURESIREMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cernficate of compliance fists the building features and pertorma= specifications needed to compty with Title 24. Parts t and 6, of
the California Code of Regulations. and fhe.admlrusmve regulations to Implement them. This cemlicate has been signed by the
individual whin overall design rescons+dtity. When trus.certificate of compliance is submitted for a single building plan to be built in multiple
orientations, any shading feature that is varied is indicated in the Special FeatureslRemarks section,
Designer or Owner (per Business a Professions code)
Nana: F_L(. k C - •Cl99cA),y f
Tidrs/Firm: /1M, NL/'
Address: S� - yUy✓G .�9�ni/E Z
Telephone: �71G U) S G� 5/ —� y� 3
Lic. a•.
(signature) (dam)
Enforcement Agency
Name:
Tillie:
Agency
Telephone:
(ugnauuvstamp) (�)
Documentation Author
Nam.:
Adtfeas:
TeMptrorte:
(.gin► (�.)
Certificate of Compliance: Residential
(Page 2 o`*2) CF -1 R
µ.
Project Title
Data
HVAC SYSTEMS
Note: Input nywon c or comornsd hydrvmc data under Water Heating Systems. except Design Meaong Load.
Distribution
Heating Equipment Minimum Type and
Duct or
Type (furnace, heat Efficiency Location
Piping
Thermostat
umo. etc.) (AFUE/HSPF) (ducts/attic. etc.)
R -Value
Type
N elU7-1'111 G
Cooling Equipment Minimum Duct
Type (air conditioner. Efficiency Location
Duct
Thermostat
Configuration
heat pumo. evao. cooling) ISEERI (attic. etc.)
R -Value
Type'
(soot or oackage)
Elf/ t Ti �V 6
WATER HEATING SYSTEMS
f
Energy
External
Ratedt
Tank
Factor or
Tank
Water Heater Distribution Number Input (kW
' Capacity
Recovery
Standbys Insulation
Type Type in System or Btu/hrl
(gallons)
Efficient r•
Loss. (%) R -Value
_ e
17-_ 111a
1. For amen pas storage (rated input S 75.000 13wmr), sieetrie resistance and hest pwnp water heaters, list Enemy Factor.
For large pas storage water heaters Iraoad input 2 75,000 etu/hr). Inst Hated Input, Recovery Efficiency and Standby Loss.
For instantaneous gas water heaters, list Rated Input and Recovery Efficiency.
SPECIAL FEATURESIREMARKS (Add extra sheets if necessary)
COMPLIANCE STATEMENT
This cernficate of compliance fists the building features and pertorma= specifications needed to compty with Title 24. Parts t and 6, of
the California Code of Regulations. and fhe.admlrusmve regulations to Implement them. This cemlicate has been signed by the
individual whin overall design rescons+dtity. When trus.certificate of compliance is submitted for a single building plan to be built in multiple
orientations, any shading feature that is varied is indicated in the Special FeatureslRemarks section,
Designer or Owner (per Business a Professions code)
Nana: F_L(. k C - •Cl99cA),y f
Tidrs/Firm: /1M, NL/'
Address: S� - yUy✓G .�9�ni/E Z
Telephone: �71G U) S G� 5/ —� y� 3
Lic. a•.
(signature) (dam)
Enforcement Agency
Name:
Tillie:
Agency
Telephone:
(ugnauuvstamp) (�)
Documentation Author
Nam.:
Adtfeas:
TeMptrorte:
(.gin► (�.)
ESAI Ni r IN"
CISY
N i SON ,%S p
L`
r..
LE GO
N 04146DRM
L�
mz
EX/ST SrAVC77AC 4 .�
,41L2�
�� // ,�V
�4-3 k 26 �i9 0SQ•FT LU
j 29'6
b
D 1 S -r1 NG LOT SIZE: /00'-O'`X J0 !
2• FJYl STING V VING AREA: f2' -311X 26'-2,r_ 1,149:0 W- Fr. �l7T�L a �.33�.O,SQ. �'�:
3. E D/T� 0 i0 5XISnive 3rRU CT- 182.0 S .r7.
N �A� � Q
PROJECT- oJ!'NgR-
FELl X CADCOA S
AVE -NIDA RAMIREZ
1-1 QUTAITA CA 92-7,53
760) 564 - 292.3
' yt
m1,
-1
/I
/4- 0
N
h 4
-4X6 \1D01)PO- W
441)2-2-
O
FOUND.�gT/DAl PCAitI
'DST
TRUC7-URAL II PLYWOOD WM4 gal d
Imoo b x o � A/AI Ls Ar 6'' �,C_ AT ED6 5 IZ' O.Cl
9x
x
j y...
{ ..Q tUcz
-x
2 x 6 s-ruo_—Q 3
6068 SL GL L)R
{ J T
A
O ,IN.
/
151-0 A l �_o ►� - '
Y2- _
u .� o� cR►c��� 5 8 % 57&fL � N
FT
Q 4 -
I
CRR CK 11 7,
� If
2x6,sT0DS 4T1bO.c
/s/$ P4y VvvdD
ArIb'Oc_
Root sN r�{in/6 s/e OLYWOOD /Od
.`
I :dA1DAr6'O.Cr,E
.ADC,FS %12"C
D..
FIEL
. TO o F
OD 2 -TOP KhTSE
� 2X sTupS flT i 6
f l N S/ "loop
I i I I I `9 'rYPI CAL RIP D� p ETA0 L—,-PLYwvov.
I ii I ZX- 4EDOER
I f f I f �Fd R RA F7 -,c -;FS 2X_I244FTE S- `
Z-T_0_P_P1AM
I q I I t 2xi6 sTU DSAT 16 0._C, f R�13 tNSU� A71oN
2-- RA "�c Alr
14-�r
i I � fl to
H®®� FR9NrlI�� �����_
A
o
o:
o
�
,
x .O
OA'!
:, ;
d D
CI
N
N.
�- EXTERIOR 6TOCCO
2 �"STRU�'l. PLYjy�`oe
3_ zew, STUDS( l6" O.c
¢-,2` XV 45I LL PLATES 6W/
5 R.22INSULATION
6. 11r O R)6VALL
8
/
gvcT ., 5 of SONG__
-72'� aC. Aloft i l
_QF_C_ORNERS AND-_S��GGS
_
cfN
c
DETAIL A
TYPICAL EXTERIii OR, F007-/1YG
,
2-R- tMSULAvom
�. -4tI-RA7 s
;z
4
T. -
DETAIL ,g
TYPI CA INrEIRlPR FDoTING DET'A/L
-BETWE�PY EXISTING STRUCTURE-.
AND PROPOSED ADDtTIo#
IRON
110,
541c
4 �/
Pbjo
o�
M
i
- Y
r
nil
I'm
d Z
� n
1
Bcc,D,P
JO
W
�,
Do
2
N_L.J
y
�t3l�W ��nod
-1 a
4 �/