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15632 (MISC)-4 P.O. BOX 1504 BuilAddress 78-680 Calle Tampico 7UINT CALLE CALIFORNIATAMPIO LA OUINTA, ORNIA 92253 Oivner Janet Diai'.nsr Mailing Address S6Me City Zip ITel- Lake Qui.nta, dh 92253 564-0082 Contractor owiier/llui der City . IZip I Tel.: State Lic. City & Classif.. I Lic. # Arch., Engr., Designer , Address Tel. City IZip ( State Lic. # LICENSED. CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of Division 3 of the Business and Professions Code, and my license is in full force and effec, $LGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing' wrh Section 7000) of 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 by any applicant for a permit subjects a applicant to a civil penalty of not more than rive hundred dollars ($500). Ls owner of the property, or my employees with wages as their sole compensation, will ddthe 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 6v 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 Inprove for the purpose of sale.) O 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 p%perty who builds or Improves thereon, and who contracts for f sucNprojects with a contractors) licensed pursuant to the Contractor's License Law.) ID II am exempt under Sec 1 B. & P.C. for this reason Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or.a certificate of Worker's Compensation Ins rance, or a certified co�py thereof. (Sec. 3800, Labor Code.) Policy NyrY * 4 79!'mCompany 144 I 13�6py Is filed with the city. 0. 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: ff, 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. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. This is a building permit when properly filled out, signed and validated, and is subject to expiration if 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 applicant Date Mailing Address City, State, Zip No. 15632.1 LDING: TYPE CONST. OCC: GRP. P. Number ,I Description ect Description Addition of 12 R 26 bedrom ,d installation of gas piping to kitchen. Sq. Ft. Size 168 No. ' Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ElDemolition ❑ Estimated Valuation M1220'00 PERMIT AMOUNT T Plan Chk. Dep:.; Plan Chk. Bal. - Const. 3, 17 J Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL _ids 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: I IJ L Validation: I v I 1 By CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES A.C. UNIT COLL. AREA SLAB GRADE 8 /� 1ST FL. SQ. FT. ® $ UNITS HEATING (ROUGH) STORAGE TANK FORMS X 3 YARD SPKLR SYSTEM 2ND FL. SQ. FT. @ DUCT WORK ROCK STORAGE FOUND. REINF. O /6 /J MOBILEHOME SVC. BAR SINK POR. SO. FT. ® OTHER APP.IEOUIP. REINF. STEEL /�! fI GAS (FINAL) / POWER OUTLET ROOF DRAINS r GAR. SQ. FT. ® GROUT WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. SQ. FT. ® WATER SYSTEM WALL SQ. FT. _$ DRINKING FOUNTAIN FINAL INSP. URINAL SQ. FT. ® ROOFING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL FINAL INSPECTION CERT. OCC. SQ.FT.GAR ® 3/ac 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 & AIR COND. SOLAR SETBACK S( /G �' GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE 8 /� ROUGH PLUMB.- BONDING HEATING (ROUGH) STORAGE TANK FORMS X 3 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. O /6 /J GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL /�! fI GAS (FINAL) / TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING. cu. yd. $ -plus-x$_ _$ LUMBER GR. FINAL INSP. FRAMING /� FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING'"� FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND ` FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL :;Rivica:e Of �Gl*biiancs: Res' 'en�tial .(.Pace � or �) LF -1 R late CO ofect Address. 8uddtnq Permit . �Dff^ G '� Plan ChecK i Date xumentatfon Author Telephone Field ChocK i Date amplianee Method (Pacxage. Point System or Computeri Cllmate Zone cnforcoment Agency use Only !ENERAL INFORMATION / v otal Conditioned Floor Area*�to O q2 'Wilding Type: /011 Single Family Addition 1 _ :heCK one or morel Multi -Fit Existing -Plus -Addition ,vont Orientation: North / s / outh , West / All Orientations 6 (Inputo; to I green and circie one.) Vumber of Dwelling Units: :Ioor Construction Type: ' lab / aised Floor (circle one or both) MLDING SHELL INSULATION Construction ,,omponent Insulation Assemoly LocatiorvComments f e R Value U -Value (attic. to garage. typical, etc.) Wall .............. ( . xr Wall .......... ...... - ... -r Root ............. Roof ............. Floor ............. Floor ...... Stab Edge .... • FENESTRATION Devices Overhang Fenestration Area Fenestration Interior Exterior Framing Type Orientation (St) U -Value (roller b(ind. etc.) (shadescreen. etc.) Ives/no) (metalnwoodNinyl) Front..... ( ) f=ront..... ( ) Left.....,. ( ) Left ...:... ( ) Rear ..... ( ) Rear ..... Right..:.. (c) o Right..... Skylight ....... Skylight ....... THERMAL MASS Type/Covering Area Thickness slab/exposed. tile. etc:) (sf) (inches) Location/De scrt tion (kitchen. batn. etc.) / A" Czid 0 v B- -r 1—..... 4029 w Certificate of Compliance: Residential (Page 2 of 2) CF -1 R Project I ilia Date . HVAC SYSTEMS Note: Input hyQronic or combined hydrornc data under Water Heating Systems. except Design Healing Load. Distribution Heating Equipment Minimum Type and . Duct or Type (furnace, heat Efficiency Location Piping Thermostat pumo. etc.) (AFUEIHSPF) (ducts/attic etc) R -Value Type 'Cooling Equipment Minimum Duct Type (air conditioner, Efficiency Location Duct heat pumo. evao. cooling) (SEER) Thermostat Configuration (attic etc) R -Value Type (sold or Dackage) WATER HEATING SYSTEMS Rated' Tank Water Heater Distribution Number Energy' External Factor or Tank Input (kW . Capacity Type Type in System or Btu/hr) (gallons) Recovery Standby' Insulation Efficiency Loss (%) R Value -- 1. For small gas storage (rated input s 75,000 Btulhr), electric resistance and haat pump water heaters. list Energy Factor. For large gas storage water hseters crated input a 75,000 Btu/hr). Inst Rated Input, Recovery Efficiency and Standby Loss. For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency. SPECIAL FEATURES/REMARKS (Add extra sheets if necessary) COMPLIANCE STATEMENT This certificate of compliance lists the building features and performance speGficaGons needed to complywith Title 24, Parts t and 6, of the California Code of Regulations, and the administrative regulations to Implement them. This certificate has been signed by the individual .nisi overall design responsibility. When this 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 Features/Remarks section: Designer or Owner (per et„ l"1.s, a Professions code) Document tobAuth Name: e 16Sc� Title/Firm: \Name: \ .. Titte/Firm: 1 Address: t Address:L1^ a► - 2253 v..I. , 't q Telephone: Telephone: �- 1 Lic. s: (sinature) (date) (signature) O Enforcement Agency. Name: Title: Agency: Telephone: (slgnatureistamp) (I tiwlsed January 1992 AW, �l. r jl r AUG -10-1995 11:17 AAf;I LA QUINTA P.01 rr to77 INTERINSURANCE EXCHANGE of the Automobile Club.of Southern California _ MAILING ADDRESS: P.O. eOX 25001, SANTA ANA. CALIFORNIA 92799-5001 FRN CP`�� EVI®ENCE OF INSURANCE' Mortgagee: LOMAS MORTGAGE,USA ITS SUCCESSORS AND/OR ASSIGNS P.O.BOX 600721 DALLAS, TX. 75266-0721 Loan Number: 8328 2 Insu8res Name and Mailing Address: DIEMER, JANET, A MARRIED WOMAN AS SOLE AND SEPARATE PROPERTY 78680 CALLE TAMPICO LA QUINTA, CA. 92253 Location of Premises (if different from above) Limits: Dwelling $ 199,000 age Ai Policy contalns 4382FU in favor of Mortgagee shown. ' Policy Number: -ar PH 321 83 46 + Policy Type: ' Deluxe Homeowners Form Effective Date: 12:01 'A.M. Pacific Stendard Time Renewal Date: 12:01 A.M. Pacific Standard Time B-8-96 With respect to the interest of the mortgagee only, this policy has no'fixed date of expiration r" but will continue for consecutive terms of 12 I months each, beginning each year on the A s Renewal Date.' The Exchange will give the mortgagee 10 days' written notice of termination or lapse of this policy. Deductible: $ 500.00 • I A , In case of loss, we cover only that part of the loss over the deductible stated. -1 -Annual Premium: $1 ! 1629.00 PROVISIONS: This form is not the contract of insurance. The provisions of the policy shall prevail in all respects. ; All premiums for the insurance policy shall be computed in accordance with the Interinsurance Exchange of the Automobile Club of Southern California rules, forms, premiums andl minimum premiums applicable to the insurance afforded which are in effect at tie r Inception of the insurance and upon each anniversary thdreof, including the date of interim changes. It is understood that should the insurance protection evidenced herein terminate for any reason, due notice will be given to the Insured, to +; the mortgagee, and to all other interested parties in accordance with the standard mortgagee clause (43815FU). w !:. , J • , .-+``e. _•....,... r. rnlstrlctE? i - ,=- �� 1b .�at�^8 5 n r ... q..- `�.. y 1 t;• 1,- !' d! >a fes+ _. � ., ''�,= S f r a ` 2 -'{;. ri r:.r:.���. ( 1; � �� 5CreditNumber40--47 B r : ya. - AUtn rize eprosanletive► i • - + MANUELM. RIGS—- r ` <—`—-—--——--� --—. ——— — — — _ — — — — — — — — — - I *, ?°s,{c;� T INTERINSURANCE EXCHANGE of the. t �r NOTICE OF PREMIUM CUE ,V' Automobile Club of Southern California ` . I \"?rtp •,p�` MAILING ADDRESS: P.O.9OX 25005. SAI -JA ANA, CALIFORNIA 92799-5005 . r , I' Policy Number Due Oate Premium Due I 4 ESCROW: - I , . PH , 321 83 46 8-8-95 $679.00 ; PLEASE DETA CH THIS' BILI. Aft . I i Ing Addr'e55ti • "M I Insured's Name and Ma f RETURN WITH THE PREMIUM.DME I DIEMIJR, rAr;ET R ' BY THEDUE DATE. � I 78680. CALLE TA4PICCr f t. -LA QUINTA, rCA. 92253. `r MAKE CHECK PAYABLE TO ACSC. ' ? ;r 'n _ _ , request. rentdelr VAHY _ S Tlf)N AND �1AB1 net MPEM- `��j'.. assumed by an insured under any contract or (4) an insured shall, at our statements, under oath If requtred, Y EMPLOYERS' /� I r7 describing the lads and circumstances, including /` 0 those relating to coverage; is made or. suit brought against an damages because of such injury or death resulting . fL (5) no insured shall, except at the insured's own cost, assume _arty COVERAGE F— OR AT(ON of injury to a residence employee, will consider that notice or knowledge or. our voluntarily make any payment, obllgatton or incur any expense other than for fiat COVERAGE G—EN1 YERS' LIABILITY we r p art; aid to others at the time of bodifyinjury; under the vrorkers' cornponsation any other workers' compensation or occupolional compensation or (3) the jurisdiction of an Insured will, lot the purpose of the law imposing liability lot compensat_ivn, be {fi} under ADDITIONAL PAYMENTS—PART TO PROPERTY OF OTHERS(c). The disease .law„ any unemployment disability beriefIts law, or-under.ariysimilar law; , , i the jurisdiction of the Exchange . 11—DAMAGE Insured shall, within 60 days after the loss, give us of loss and make the damaged ,KHAT LOSSES ARE COVERED—COVERAGE F -AND G (4) we will in all things be bound by and subject to the decisions_ or awards rendered a sworn statement or destroyed property available for our Inspection COVERAGE employees vl an insured we will: orders, .findings, against an insured under the provisions of the lar: for compensation, subject 1D the it the properly is within the Insured's control. With respect to residence - imposing liability provisions, conditions and limitations of this Part. (a) under . COVERAGE F—WORKERS' COMPEN- i This Part -shall govern as between an Insured ar:G w us as to payments by either in discharge of an d) Duties of an Injured Person—COVERAGE SATLON—pay promptly when duo all compensation of an Insured by the insured's liability for compensation. E—MEDICALPAYMENTS TOOTHERS and other benefits required `'(c} Under COVERAGE G --EMPLOYERS'- LIABILITY— liability stated below Ls the total limit (1) The injured person .or someone acting on behalf workers compensation law; i COVERAGE G—EMPLOYERS' LIABILITY—pay only, the limit of ? of our liability for all damages because o1 bodffy of the injured person shall- (i) us written proof of any claim and any (b) under on behalf of an Insured all sums an insured shall to pay as damages because inJury: 1:7 {t) by accident, including death at any time: resulting sustained by one or more resfdence give further Information requested by us, under it requIre d, as soon as practicable; become legally obligated of bodily Injury: 2 oath {ii) execute authorizations to allow us to obtain (1) sustained in the United States of American its i territories or possessions, or Canada; or 1 A copies of medical reports and records. temporarily outside the United t therefrom, sustained r ernpioyees of an insured. r (2) The injured person shall submit to physical examinations by a physician selected by us when (2) sustained while States of America, its territories or possessions, i ada if the injured citizen or ' t and as Often as we reasonably require these �esiden t of the United States or Canada. (4) Agreement for .defense. and settlement under! 'ti (d) nrhicharo her vatl dpa-nd. collee#tblor Veorker- Il—COV.ERAGSARE examinations. This coverage appliesonly to: ' I PART COVERED;�iAI LIABILITY—WHAT LOSSE (e) payment of` Claim—COVERAGE E—MEDICAL PAYMENTS TO OTHERS (1} injury arising out of and in the course of employment and occurring during the policy employ }¢ person or am person or We may pay the injured p-. - y Payment by us shall � period: oc ' i p FF organization rendering services. reduce the amount we owe. Payment by us is not an (z) or cumulative injury of a occupational disease ernpfoyee who during the term of this {6} Duties After- Loss, Duties of an Sults Against Us, Bankruptcy of an Insilred'under admission: residence policy actually worked for an Ensured during the PART II—COND1710NS{c}, (d), (f) and. (g)• (1) of liability.by_usoraninsurad; Iasi day of covered employment which exposed T ! Inierinsurance Exchange ol•the Automobile {2} that the -medical expenses were reasonable or covered under. this Part, the employee to the hazards of such occupational j disease Or cumulative injury. Covered insured ^'GQ-• necessary or otherwise empioyrnent means employmenk for an CE (f) Suits Against Us who possesses compensation coverage. Suit under this policy Ion the recovery of any claim us until all .ter ms of this shall not be brought against ----policy'ltave been -fully • complied -with.-No-one.shall lawsuit to LOSSES ARE NOT COVEIgED—EXCLUSIONS--- have the right to make us -a party to a determine'the liability of an insured. to addition, WHAT COVERAGE F AND COVERAGE G OD under COVERAGE D—PERSONAL LIABILITY—suit us until the obligation to Under COVERAGE F—WORKERS' COMPENSATION— EMPLOYERS',LIABILITY—vie do'not not be brought against ay, by an Insured, is finally determined elther by and COVERAGE G— pjudgment against an Insured after actual trial.br by arn insured, the claimant d us. cover: imposed on an {a) 'liability for additional compensation IV, written agreement of an Insured under Sections 4553 and 4557, Division (g} Bankruptcy of an Insured Labor Code of the State of California, by reason of the misconduct of insured y anto LT) m Bankruptcy or Insolvency of an insured shalk riot us of any of our obligations under this polLcy. serious and willful rep Or bre asonju resentalive of anrelleve 1,6 red of rage and I Illega ally employee under years i (9 'A {h), Other Insurance—COVERAGE D—PERSONAL employed at the time of injury; C� `C1 LIABILITY over any other valid and (b) liability for compensation due a residencu ernpfoyee for injury or illness sustained while engaged In This Insurance is excess collectible insurance except insurance written services in connection with the business ,'of an I4 �-� specifically as .excess over the limits of liability applying In This policy. If the other Insurance Is writtenCDVERAGE insured. Under G—EMPLOYERS' LIABELITY—we do i by us, only the highest limits of any Ol the policies not cover: . /._ apply. _ _ , • r - tit `.7 `��j'.. assumed by an insured under any contract or {b) . Under COVERAGE F—V�IORKERS' COMPENSATIOk, - (a) liability agreement• injury by disease, unless prior to thirty-six —only:_. 1 we shah be directly.acid Niinurily liable t, '^'r l ) to tee residence employee of an insured. l FJ_ {b} bodily months after the end of the policy written claim insured.- for ion w tr benefitsthe workers' compensation law under 0 is made or. suit brought against an damages because of such injury or death resulting . s potlsco y. , (2} when an Insured knows of or is notified of the J �.- therefrom; for which an insured or any insuranceoccurrence of injury to a residence employee, will consider that notice or knowledge or. our (c) any obligation be held liable company as that insured's insurer may law at California, we r p art; under the vrorkers' cornponsation any other workers' compensation or occupolional compensation or (3) the jurisdiction of an Insured will, lot the purpose of the law imposing liability lot compensat_ivn, be disease .law„ any unemployment disability beriefIts law, or-under.ariysimilar law; , , i the jurisdiction of the Exchange . (d) any suit brought in or any judgment rendered by any America, its (4) we will in all things be bound by and subject to the decisions_ or awards rendered court outside the United States o1 . `territories or possessions, or.Canada, or to an action orders, .findings, against an insured under the provisions of the lar: for compensation, subject 1D the on such judgment wherever brought. - imposing liability provisions, conditions and limitations of this Part. " This Part -shall govern as between an Insured ar:G w us as to payments by either in discharge of an insured's liability for compensation. CONDITIONS—PART III `'(c} Under COVERAGE G --EMPLOYERS'- LIABILITY— liability stated below Ls the total limit only, the limit of ? of our liability for all damages because o1 bodffy (a) In addition to the provisions and conditions contained of the policy inJury: 1:7 {t) by accident, including death at any time: resulting sustained by one or more resfdence in this Part, only the following pro6sions therelrom, employees in any one accident; apply to this Part. (1) AGFtEEh4ENT; } , {2} by disease, including death at any time resulting by one or more resfdence () DEFINITIONS; therefrom, sustained r ernpioyees of an insured. (3) CONCEALMENT AND FRAUD, TERM1hyATION„ n ol re an one Ofniiabilliit'h-of SUB OGATIONuOnderGENERALPROVISIOI3Snd - not�operaen toeYincreaseoourhlimiit $100,000. (4) Agreement for .defense. and settlement under! 'ti (d) nrhicharo her vatl dpa-nd. collee#tblor Veorker- Il—COV.ERAGSARE PART COVERED;�iAI LIABILITY—WHAT LOSSE Compensation or Employers •.Ltah,kty insurar;ce (5) Claim Expenses .under PART- 11—ADDLTIONAL applies. ' PAYMENTS(a); r injured .P.ersoo, te) .The terms 01 this Pari nhich are in .Conflis,•l vriln the la3tir ar-� hereb; {6} Duties After- Loss, Duties of an Sults Against Us, Bankruptcy of an Insilred'under rovisfons of a vrorkers compensation omended to conform to such law. PART II—COND1710NS{c}, (d), (f) and. (g)• - T ! Inierinsurance Exchange ol•the Automobile po Club.of Southern. California has caused this licy to 'In Witness Whereof, the be executed by its Altorney-In-fact at Los Angeles, California; ACS Management Services, Inc: ATTOR NEY-1N- FACT r 'b C71AO".42A *Y1 by SECRETARY y . 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