9709-114 (SFD)LICENSED CONTRACTOR DECLARATION
1 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 #(Cyy yy
Lic. Class Exp. Date }}
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:
as owner of the property, or my employees with wages as their sole
Acompensation, 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 arn.exe6pt under Section B&P.C..for this reason R
Date ^ 1 `� L r� Signature of Owner_..r`�
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.
fr~t��,(:<�l�t:�;1 tl21.It)? .43".''0 flt) 9:;
(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�those-provr ions,;.
Date: "'; `' j'r..6%rA�plicant �?,
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. I e
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
14
2,gnature
uabove-mentioned property for inspection purposes. (Owner/Agent)' -�"� %' "' Date
PERMIT # CONTROL #
BUILDING PERMIT 9704-114 5 979
DATE ( ffrhq VALUATION 577,361.20 LOT 9 TRACT ROO VIA )y
JOB SITE
ADDRESS%�e�►�� :% f ��
APN 773 -172 -OZ
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A(3.NFr' AN DO :: A :,raRU
:UNNE11 d MILDER A"(TH (INI t 1
429 0s).."EFRI.H i3 ND
45701 nrONRO�E &I'SM tJ
CC►Atm'hl� �,LA "A. «11136
11N1140 � t A �?°?01
USE OF PERMIT
,f lu- to li' D+3L•' Ni5f. iM°Lida N3.' : `ib'�t .i,�: �i2('C:}iri..
fZi�\"a i`.tJik sl �LkJk'�:ia�J i.Z110_00 114
IV11100 SI'
«.ltifOVQYCuP°'FiFfs'OW1' `s 1 t#_i SF
A°n9T8li9t F.E.I.) 0..��ti.l�'l�i,
00N
4't, Alf ('! TA�r~!� ►.' !� #r 1 t1 i-t�f0f1•-�,���3i � R.i�, aid
'f.,1nf.",E.--�I ��k�riia �.'L:ii �v!'�'Y{,17"l7•.)li �). 1�1:.{i
i�i.lt91'f�ftz~t4i E.%`l�iS 3E�!-tftM�•.1#��-�li1f) !�9::1 fi
C'XF(,'f.:h'.V1,,AN AUt-f►Oil- ) :ti; s $2SJ0
A,Ni.l TaC.:3tu f;'}i-FC"F
OCT 16 1997
.
°!f'Ili1°A1, �'#i'R!A91IT V t�,f� S 001. 1�t}'�'
.i337. _4
�^e(^�� r �i
`�11 t i OF CaL���E����Sb�i
RECEIPT
DATE `
BY
DATE FINALED
INSPECTOR
)3
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
xhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
�y 9
a�
Final
Final
BLOCKWALL APPROV LS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROYVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
COMMENTS:
ELECTRICAL APPROVALS I
Power Pole
Low Voltage'
Fixtures
Main Service
Sub Panels
G. F.I.
Smoke Detectors
Temp. Use of Power I &I — 4Z A MI -7
Notice
Comments
At the present time; the Desert Sands Unified School "District does not collect fees ons 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
X 1;210 or $'2,226.40 the. property. listed above and `that building
Permits and/or Certificates of Occupancy for this square footage in this proposed project may now.be issued
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the SI day approval period in which you may protest the fees or other payment identified
Dove will begin to run from the date on which the building ovinstallation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to.
Alect 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
Coachella Valley Housing Coalition V I
Plaza 1; 45-701 Monroe Street, Suite G., Indio, CA' 92201
- t
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 4
property described below.
All that certain land located and being in the County of Riverside,
State of California, described as follows:
LOT 23 BLOCK 60 OF, UNITS OF SANTA CARMELITA AT VALE LA
QUINTA, AS SHOWN'BY MAP RECORDED IN BOOK 18, PAGE 63 OF 4
Y < MAPS, RIVERSIDE COUNTY RECORDS. s
:Date Armando Ramirez
YY
Ab►
TM
THIS ATTIC HAS BEEN INSULATED T0:
This attic has hcen insulated to the It -value
indicated above, with Cocoon" the high -efficiency
insulation. Made from a minimum of 80% recycled
materials, Cocoon is scicntilically formulated
to deliver greater efficiency per inch than other
insulation materials.
R•valuc is a measure of resistance to heat flow — the
higlicr the R•valuc, the gmatcr the insulating power.
If you would like to add more insulation to your
home, contact your Cocoon authorized dealer.
RESIDENCE ADDRESS:
ve. r au.
{
INSTALLED 114rk n0"O,� -n44-,t11L�/
BUILDER: U4
CERTIFICATION:
This is to certify that attic insulation has been installed
in conformance with the coverage chart recommenda-
tions on the olvositc.side of this card using bags
to covcrtq, ft. to obtain an It -value out.
7NSTALL 'S AUTHORIZED SIGNATURE DAT
;`
• ��!. •/�((Q�� '� " tip ,j rC' � � it(� - it ' r) ` 11 f ,;� ' . '', I' `� i� i' � :;` , j i
�,r�,^+7�e�,.. )i rj JP'[ .i f �•i irk' 1YC' i '� !j/•T R'1, .� �.. {,��? . '�'�!!• . ..
,a•c-'' Ift t'77< n.r / .r •i' .f ,J` A 'y t ) {t'
f` fir' r 17
, cJ
:n:� ,YN z.,�:..1,.,,.- i3Ocooll stab1l1%cd Insulation .
30 Ib. hag
dhuu!Ji1, 1, IN /4r •.
GREENSTONE:".
A LOUIS I NMN -PAC IF IC COMPANY
NOTE: 'Phis Lan'crage rhmi I--p. �n.atc.. linxvling
and is (i Ir cmimmiog Purp.I's nd, SCnrJ Ibr:duc is
prnvidrJ by imlidliog 11 n•yu in.I ......dx•r .d hal:.
1wr IWO ml. Ii. :n a minimum in.Iallr•11 Ihirkno..>.
In>Iallatinn r.l Ilk• -1,6-1 nundNr .d h,g;% nlay yiela
nN w Ihml Ilk• slx•rilnxl mi..im...n Ihi,'kur.n :nal minnuum
a'L•il:hl per .sq. li. :\rlu:.t r.,ror:p;c ,rill la• i..11uonre.I
by j,.h *..odoints : I ..Iyh.*:ni,m lerhniyu.•.. .old
miry cagy as murk an lin. ,udnnn .1µn11.. .nilh
alfeclinµ if., mmcd 11-,d..L•. FAh."..ddlo inslallor ...
pu...W, m Ica..l 11 uv 1.6.vd uuulhe, .d hu J;. lu•1
I(HK) sq. li. and m Icasl the minimum Ihirknc» mac
resull in a borer installed H-v;iluc. I:nny,:utilm nl.rr
-,,or dminl: insCdlati.nu ;dNmc It :N I. n•ynirinJ; nuue
I fan the shoed ..umber ..I haµ> 1., ..Main the
miuim..m ioslallcd (hick."..".
r., GleenSlone and Cocoon are Irademaiks of
I GreenSlone, a Louisiana-Pacific company. 1::1 1197
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
IGValue. al
19.4
Net Coverage. No Adjw.l :W Im I sms
SG.7
15'F Mutt
Mio.rom.
5.5
Gloss C.e.l (p: Based on
k4„immn Nei
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Imullerahoe
thickness
2' . G busses un 16- COO'S
C,over.uln
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1. 014.1 art
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haw. Itwini.ed
Insukuuxl
.Ghnuhl Nut Ik
tiguau1 l'ecl
IlegnueA I'cr
Iu51,dIcA
Squ.uc I cci
1'cr 1000
IleScaarlee lNl W:
Ien. lh.m:
1'er Nag
11X111 Sgnau: I,•e'
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13.5
20.5
48.8
1.4154
21.3
4G.9
R-42
11.4
24.4
41.0
1.2.30
25.6
39.1
R-40
10.8
25.16
39.0
1.171
2G.9
37.2
R-38
10.3
27.0
37.1
1.113
28.4
35.2
R-32
8.G
32.0
31.2
.937
34.0
29.4
R-30
8.1
34.2
29.3
.878
36.5
2.7.4
11-24
G.5
42.7
23.4
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21.6
R-22
5.9
4G.6
21.5
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51.0
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R-19
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53.9
18.5
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59.5
1G.8
R-13
3.5
78.8
12.7
.381
87.0
11.5
R-11
3.0
93.1
10.7
.32.2
102.3
9.7
A GicooSlnne Indusb..:s, Inc. All tit
films n:::urvcd
I'linted in USA. [IV 3UM 8/91. SI-I'malls (1110s::um lillr•-d-drnsily 2.0 1.1.011
8-97-TT/G-A
R 13 (2 x 4)
3.5
51.4
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SG.7
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