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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
12/3109
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).
(y) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
()A am exempt under Section B&P.0 forthis reason
,Date
�%' / 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.
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(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 thop�rtov ions.
/Date: 6Applicant / .4e`r �.---'
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 propeZfm,'nspecfion purposes.
/Signature (Owner/Agent) Date -2 01Q_':0
BUILDING PERMIT PERMIT#
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DATE (f VALUATION LOTTRACT
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OWNER
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck e,
Exhaust Fans
F.A.U.
O.K. to Wrap
Framing
Compressor
Insulation 7
vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath S'- 7
Drywall - Int. Lath_ T
E z 49
Final
Final L
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beamif
Approval to Cover
i
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 - T
Encapsulation
_72
Gas Piping
Gas Test 16Q
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APP OVALS
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) L
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Notice:
Document Cannot Be Duplicated
Date 7/28/98
No. 17396
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 773-174-004
Jurisdiction La Quinta -
Owner NameCoachella Valley Housing Coalition Permit #9807-099
No. 51-820 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 of.
1.93 X 1,302 or $ 2,512.86 the property listed above and that bdifdin'g-.r
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permits and/or Certificates of Occupancy for this square footage in this proposed project may now lie -issued rlf
Fees Paid By CC/Bank of America/David Brudviksr
Te!. -"one 3.47-3.1;57
Name on the check
By Dr. Doris Wilson {.'.'A�� `� -• L �,
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,512.86
Check No. -109+ �oc�Tq 1 I(o3
Signature
NOTICE: Pursuant of Assymbly 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.
i
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 i
Plaza 1, 45-701 Monroe Street, Suite G., Indio, CA 92201
TEL: (760) 347-3157 FAX: (760) 342-6466
fit,
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 4 OF BLOCK 62 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.
(a NUt A.
Date JORGE O EDA VILLANUEVA
rt
f:lsfamilylannalmiscforlattnyfa
Affordable Housing Program
FHLBank Attachment 913: Project Readiness
San Francisco Building Permit Readiness or Issuance
General Information
Project Name Parcel Number
Regional REO Rentals 773-174-004
Address
51820 Avenida Velasco
City County State
La Quinta Riverside CA
Building Permit Readiness
Is a building permit(s) ready to be issued by the appropriate local government agency based on submitted and ❑ Yes ❑ No
approved site and building plan review for all proposed project units?
If yes, provide the following information:
Building Permit Ready Letter Date
Note: Submit one certification for each parcel number.
Building Permit Issuance
Has a building permit(s) for this project been issued by the appropriate local government agency based on M Yes ❑ No
submitted and approved site and building plan review for all proposed project units?
If yes, provide the following information:
Building Permit Issuance Date Building Permit Expiration Date
("-;Z9- 9e iV /A
Note: Submit one certification for each parcel number.
Has a Certificate of Occupancy, final building ermi� sign -_off, or Notice of Completion been issued for the
completion of construction or rehabilitation? M-Yes ❑ No
If yes, provide the issuance date:
a 8-a3.9'?
Attach a copy of the building permit ready letter or building permits approved and issued for this project. Points will not be
awarded if a copy is not provided with Attachment 9B. This form must be re-issued/re-executed with each new round.
Local Building Official Authorization
Local Building Offi ial Name
��127'Lfi�./ t�
Local Building Of#ici I Signature Date
~T-� q-a0-0�
FC 2262 (7109)
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