9807-102 (SFD)N L1J
O M .
I W
' oZ�
O ^o
P: C:)
J
Waw
Z
^ M
N
O�
UQ
a —
Q O
X W u-
m U U
O
a 0)
't Z_
00 5
O
J
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
CV_HC 121131A)8
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, as owner of the property, or my employees with wages s'their sole .
compensation, will do the work, and the structure is not intended ( offered for
sale (Sec. 7044, Business &,Professionals Code). r
( ) I, as owner -of the property, am exclusively ,contracting with licensed
contractors to construct, the project (Sec. 7044, Business''&•P:rofessionals
Code)., tv -
( ) Ilam exempt under Section B&R.0 or this reason t
ate : GSfgnature 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 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.
T=MCK 1:1..4'Sf;,l.tir►1' CEi 1, A2007 4371.E 00 96
(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
;at
'ect to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply with tho Oprgyisions.
e: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 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 fon pec
purposes.
4 .�”
ySignature (Owner/Agent) Date7Z �K9_�i1
BUILDING PERMIT PERMIT#
DATE J VALUATION LOT �11�-��� TRACT
�,� $77,640.70S i3ti2, f,ft
JOB SITE a+x e� APN
ADDRESS 51-840 A�`l7�te�.��f�.�'I�u�uASCO 77XJU00S
OWNER CONTRACTOR/DESIGNER/ENGINEER
MI.ti711Wt, RAM fRI"s:,' Qi:rNER / BUILDER i'l IT11 CVHC
466 8% 31_FI+''lt* )N hl, X08 45.701 141C1NRC.+1 Vit' STT G
f'NDI0 CA 92201. INDIO CA '92201
(760)147-3157 0.6110
USE OF PERMIT
SIM - PLAN 12 i.SDR. M -RM DOES NOT XNCi.W8 FALOCK'U1 AWLS Cil'#.
1104:)L.. W. KN f 1`HU,- l�, FPX U3.)UCLz f) 73%woR tviUX..'! Ipt s mwEiwn o � t }
SA'#ti, PLAN'117f.,
I,"� 15.04) SH
►,gay➢�f�i :f"At'lr+ 102.00 SFS'
(ARA+.11JC"..A.I. 'C)RT 5261.1JU';f
'1_%'Q ;-T(`tf'A!, CONISIM1lC'7ION A.NT) P1, AN CH $2,7f)113
LESS PIM-PAIDREES � $0.90
1•MAL .E°1+.RMIT T+'itWAS a:UE NOW' 1 $2,7d ?13
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
$yBe;iNfM V �"►.� E- ti001fl itY
CX.)' lS'TRik;°1I0N F1+F,
i01 f3iIG Ait# fl(H1
$Rq 1 �
P1, Al N f'tl!?t'"iG FGfr
101 8
Iti42`sr:.i;t Ed E� :ei 4.,. 1"s
10 1 - 000-412 E • ow
S4U. StJ
Ef,E07'k10A1., F EF.
101-000-420-M
Pl.k}N 11NGIEi1S
111:1-(1M-419-000
s1.",a.5ei
!e`'I'32%JNs : iv3rl`1 fO-N RPR . i'iF? 11 i
10i _000441 -(Kin
�7 76
01 RAI 6'i to
101-M--1.23-000
1210, 0
is�T112d�w'1'ttttt;i Otti5 FLE:
123-0 0-443-142 2
$ t.716.J9
k42E41.8f? PLAN
101 -OW -444.345
5123.00
'1_%'Q ;-T(`tf'A!, CONISIM1lC'7ION A.NT) P1, AN CH $2,7f)113
LESS PIM-PAIDREES � $0.90
1•MAL .E°1+.RMIT T+'itWAS a:UE NOW' 1 $2,7d ?13
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
J
Return Air
Steel
Combustion Air
Roof Deck
- Q4
Exhaust Fans
0.K to Wrap
5?
F.A.U.
Framing
j
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-
-az— -IS-
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
ow 440Main
Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_
Underground PI . 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
/—/IF — 9 r
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 4 0a
Utility Notice (Perm)
COMMENTS:
t
Desert Sands Unified School District
r 47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/28/98 APN # 773-174-005
No. 17399 Jurisdiction La Quinta
Owner NameCoachella Valley Housing Coalition Permit #9807-102
r
No, 51-840 Street Avenida Velasco Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # Square Footage 1,215
Type of Development Single Family Residence No. of Units 1
d 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 1,215 or $ 2,344.95 the property listed above and
, �that,.sbuilding
Permits and/or Certificates of Occupancy for this square footage in this proposed project maYriow be -issued
,.,• i�
Fees Paid By CC/Bank of Amefica/David Brudvik Telept6ne 347-3157 Y -'
Name on the check r� ` f •4 `-
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $2,344.95
Check No. 769H
Signature `
NOTICE: Pursuant of Asser/r61y 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 Dislrict('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 5 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.
D to M UEL ANGEL RAMIREZ
DATE IRMA GUADALUPE RAMIREZ
fAsfamily\anna\miscfor\attnyfa