9807-200 (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
MIC, i2508
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: If
( ) 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 orroffered for
sale (Sec. 7044, Business &,Professionals Code). V
( 1.) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).'
( )•, I am e� empt under Section , B&P.C. fo his reason
Date G" F. ; 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 -
( ) 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.
TRUCK 11Q`3t t,FiNC_81 iV200 7 437A) tit) 9 i
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with tho a rovlslons.
,Date: A Applicant-
Warning':
pplicant
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 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 insp tion purposes.
,iSlgnature (Owner/Agent) Date 4
3'
BUILDINGPERMIT PERMIT 9# +CONTROLN
DATE VALUATION $.42,94�•i.Stl LOT . F) TRACT J. '
r 2,32
1 /ei
a P
JOB
%:�1-460f�{e�VI.ft�V�'.EaLlCv�
APN
i7:-i)C:i-il!�3
ADDRESS+
.'
.
OWNrEIR�
CONTRACTOR / DESIGNER ENGINEER
¢ j(� r { ` ft
It.'''I A1(''10 A3J'1�f`i:+�d\111.1
(EryNcGIINNE(ERt y (fit ( � }t
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K) 601X 1773
43701 big ONROF S'i`d G
INDIO CA 92201
1M710 CA 92701
USE OF PERMIT
"(WILL FAMiLY3DWl:L INO
'
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3R RAO - PL7RAUT W.."S I� OT INCLUI).1s 13LOCK. WALL OR P. 00L. 7S` "o PLAN � �
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NNIT.d19M` ED COST OFCONSTRUC—TION
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PRfi.,C)V, 311"A:% 101.-W)0.441-345 S^S.f>r►
8IJ3 `2+kJ S..•'F.L. CVM�M.S :ay t3. AND P1 AN fiKC :-
ESS r1tE,-PAID FEE%
$0.w
01'AL PEi<N11'6' F gl RS iOV E NOW
$2,04.65
R
RECEIPT
DATE
By {
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
-
Exhaust Fans
OX to Wrap
F.A.U.
Framing
-! -Q
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 a
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 Lateral
Pool Cover
Sewer Connection
-I 5 -
Encapsulation
Gas Piping
Gas Test_
T
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:
,
.
Building
Owner
Twivl
'.4
Qgba
P.BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
r: LA QUINTA, CALIFORNIA 92253
Mailing
Address -7-7s
City - — I Zip _
Contractor
State Lic. (City
& Classif. Lic. #
Designer
Address Tel.
City Zip I 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.
DATE
NAT
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5.eusiness and Professions Code: Any city or county
which requiresnce a
Pe
rmit to construct, alter, Improve, demolish, or repair any structure, prior
requires the applicant for such Permit to file a signed statement that he is licensed Sectio
pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with 7000) o!
Division 3 of the Business and Professions Code. or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 Dy 'any applicant for a permit
subjects the applicant to a civil penalty of not more than live hundred dollars ($500)•
l" I, as owner of the property, or my employees with we as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bulsness 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 complefion, the ownerrbuilder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I'I 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
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contrac(ors) licensed pursuant to the Contractor's License Lew.)
17 1 am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
ficate
Workehs Compeaffirm
nsationthat
lnlhave a surance, oet
acertifiedfconsent to copy thereof. (Secnsure, or
3800, LaboCCode
i•) to of
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 it 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 Cali orma.
Date Owner
NOTICE TO APPLICANT., If, ager 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
Ihereby 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.
1 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 adplicant Date
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
Number -13- cl i I t3Cz�ci
I
Description _
:t Description
Sq. Ft. No. ( No. Dw. I
Size I Z, Stories Units
New [/- Add ❑ Alter O Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
AMOUNT
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 7/31/98
No. 17431
CERTIFICATE OF COMPLIANCE
APN # 773-091-009
Jurisdiction La Quinta
Owner NameCoachella Valley Housing Coalition Permit #
No.' S1-420 street Avenida Velasco Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1,302
Type of Development Single Family Residence
Comments
No. of Units 1
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:bf
1.93 X 1,302 or $ 2,512.86 v . y i ` G -f la
the property listed above and,t5at bui, ding
permits and/or Certificates of Occupancy for this square footage in this proposed project -may now ne issL Pd `t
Fees Paid By CC/Bank of America/David Brudvik� _
Tel ,P3-'--oone 3°47 3'7
Name on the check
C _�
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received
Check No.
Signature
$2,512.86
2009916227
NOTICE: Pursuant of Assofnbly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify 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 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
1 .
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:
(PLEASE SEE ATTACHED "EXHIBIT A")
Oj,�M:ajo
Date Ignacio Alvarado v
a
fAsfamily\an na\miscfor\attnyfa
i
STRUCTURAL ENGINEERING CONSULTANT
_ 54625 AVENIDA BERMUDAS. LA QUINTA CALIFORNIA 92253
761)564.0884 PkION E 760:771.3606 FAX ! .1N1 S }i TLD C W I A . C O M
June 24, 1998 ri.-• 1-120 Ave, Vol— #S
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 8 (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 construction 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 corner 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-aii-design loads `drags -and -bottom -chord loaded girder trusses. I have
found each to be in compliancewith 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 me at your earliest convenience if you should have any questions or additional requirements.
J11I�iGi Gl , -
r
De s S. Wish PE
Structural Engineering Consultant —
F�pFESS/pay
DENNIS S. WISH Z A
ND. C-041250
w
Cr
CA If
STRUCTURAL ENGINEERING FOR • CUSTOM HOMES • REMODEL • COMMERCIAL • LIGHT INDUSTRIAL • SEISMIC RETROFIT 8 REPAIR • UNREINFORCED MASONRY • RETAINING WALLS 8 FOUNDATION • 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