9709-115 (SFD)LICENSED CONTRACTOR DECLARATION
I. ereby affirm under penalty ofyperjury 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
� h
rrVi'f(l 5
Date ignature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Licens ,L•aw for the following reason:
Q,),4-11, 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).
( ) I, as owner of the property; am exclusively contracting with licensed
contractors to ,construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this'reason
Date:M°'"? Signature of Ownerl`''F"""".�.s'�'
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.
}y C y SUA+ C 1
A-1407 4370 0
0 ll<
la .
(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
?(oatede
b ect to the workers' compensation provisions of Section 3700 of -the Labor
„1 shMforthwith comply with those,.p�ovisi",
iio.a� Applic1ant'
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 for,inspection purposes. /11
m°
/Signature (Owner/Agent) w"��' ' « �" Date
BUILDING PERMIT PERMI97e9 XS CONTSROL#
DATE VALUATION $$l),,5Q,9fJ LOT i2 TRACT - Rol.
47/__20/41 -7
JOBSITS 3�'.11i
ADDRES.1- 26 dkVtA VA1.LVJ10
APN 773-172403
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A8:A.14,M C:ryRE1
OWNER/ rR}tt 011"ykLT11i X✓�1'"1t
3601 C1,a1)•i:k, MR IWAY �ti7c"sl
43701 AXrN;> O 11' 9rE. G
PALM tiT'1tINGS .GSA 9V612
TN010 CA, 9220.1
(740)347-3.1.57
USE OF PERMIT
fiRMff NOT 1NCLUDEj3 .itt,'.K LVAU,8 OR PXX)L.
0 �3M+W a' SF 4o•r1.s:;T v�tastcwC"���r'ti I;AS�.fsQ ar
i iAI3 e1� il-ll;Alt��f3l�q'' 5 a41(Y9[
&STIV-41A. A.?1✓CONS9. OFCUsTSTPUAY,.f0..SON
�:"��tt\1171 i..i4' Yi+:� •D4,,11i1��62���
.
i�,!-�i)(}()-�tkS-(3i}U �S54.t�E►
��•LrG''�'1t7I16�F�:
¢11, ARN ri�'iFCl\ M. 11)%-0,(.�•4V_319.
r r"n r t k�'r a v r; r !d1rrL.b2,;l-i"fl�kt.[1.0..1�t.1. 'i Vrt 0 At
'
04�E MCAL FEE QA4ViVWV• F7, Ja(/
.
1%limsi KQ FFIR 103-000.4194?tO 1?f Se)<
Y' M,011! ON "T - WN; 1) 10t -000-M4 "I SRI*
GRAOUSIG FIX < 0.423-wo
11,R.E CI $3s Pi, AN
ISUWK�"P oAL C 0NS'M1.KTf (,) AND PLAIN x"341—ECK
LESS .1ii-$1i+1Li I. A:sf
T4.Yiz'A1...11CR_r11T VV%S JW.i!�NO44f'
r t_
RECEIPT
DATE
BY r;
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
Exhaust Fans
O.K 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 Wali Firewall
Exterior Lath
Drywall - In Lath
Final
Final ULPOOLS
BLOCKWALL APPROVALS
- SPAS
Stedl
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
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
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
Utility Notice (Perm)
COMMENTS:
a
Desert Sarids.Unified School'DistHct :
Notice:
82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE'OF COMPLIANCE, ; L
Date 9/26/97 APN # 773-172-003
No: 16117 Jurisdiction La Quinta
Owner Name Coachella Valley Housing Coalition Permit #
No. 51820 Street Avenida Vallejo Log # a
City. La.Quinta zip 92253 Study Area
Tract # Lot # 22 Square Footage 1259
Type of Development Single Family Residence No. of Units 1 ;
Comments ~
I
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
1.84 X 1,259 or $1,316.56 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may'ntiw be issued
Fees Paid By oc/Bank of America/CVHousing Coalition
x ` Telephone 3;;4_7-3157-
Name on the check .'
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,316.56
_\ Check No. '2006711031
Signature
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 913 -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
tolled 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
;l •
Coachella Valley. Housing Coalition
�.
Plaza 1, 45401 Monroe Street, Suite' G., Indio', CA 92201 r —
TEL: (760) 347-3157 FAX:, (760) 342-6466 -
`` °•',; 'ATTORNEY-IN-FACT.AGREEM_ ENT +
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 µexecuting, any notices of completion, waiver, of liens
and/or. executing contracts with subcontractors,u and/or*,release•of _
" liens and/or handling building permits relating to that, certain real 4 ~.
pro.perty�described below. "�;7.
'
All that'certain-land located and
being in the County of Riverside;
• ' - 'State ofCalifornia;, described as follows: ' ` ` °' - '
'LOT 22; BLOCK 60 OF UNIT- 5 OF SANTA CARMELITA AT HALE LA r
i 'QUINTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 63 OF +`
MAPS, RIVERSIDE COUNTY RECORDS. -
t.i ' t 'S._�' ♦ 'E• - - Al _
Abraham . G. Perez y
T Date'. icia Per z y • °��
1
1
a� pT
ZZ
!
.�Y.•�r.
F �L,
ai
"Al ta�S
$ Al
{ } ��S • Z b �yF �Al�r
i4.a q
L - � T�...i Sm .vaY "��"'y„` y^�" �iaa .WF•�'l:�}rM.s
y •" s cK .�ie'� tt��'"� NV"ti� �k. M ���"=P 'h 3 kz s ..3 Y � r y*!i� � :, �� n
n 'Y^irT' .:r t � f:. cyp� "� r "�A=�'. .ra•r �Tyj';� e,tar '^i'+�:3�'MS �' �'
��"' .�:'w. a.,. £.,:i i�•tW.ln!� � -��.;� ,°p'CF�q:�!.pYr—�. �a,�ry�' ��'�`.;t3.e'�fr►�iG
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
R -Value at
19.4
Net Coverage No Adjustment for Trusses
56.7
75'F Mean
Minimum
Gross Coverage Based on
Macimum Net
30.6
1
Minimum Weight
Temperature
Thickness
2' x 6' Trusses on 16' Centers
Coverage
Per Square Foot
Installed
The Weight Per
To Obtain an
Insulation
Minimum Bags
Square Foot of
Bags Required
Insulation
Should Not Be
Square Feet
Required Per
Installed
Square Feet
Per 1,000
Resistance (R) of:
Less Than:
Per Bag
1.000 Square Feel
Insulalion
Per Bag
Square Feel
(inches)
Should l Be
(bs
Less Than: n: (lbs.)
R-50
13.5
20.5
48.8
1.464
21.3
46.9
R-42
11.4
24.4
41.0
1.230
25.6
39.1
R-40
10.8
25.6
39.0
1.171
26.9
37.2
R-38
10.3
27.0
37.1
1.113
28.4
35.2
R-32
8.6
32.0
31.2
.937
34.0
29.4
R-30
8.1
34.2
29.3
.878
36.5
27.4
R-24
6.5
42.7
23.4
.703
46.4
21.6
R-22
5.9
46.6
21.5
.644
51.0
19.6
R-19
5.1
53.9
18.5
.556
59.5
16.8
R-13
3.5
78.8
12.7
.381
87.0
11.5
R-11
3.0
93.1
10.7
.322
102.8
9.7
R-13 (2 x 4)
3.5
51.4
19.4
.583
56.7
17.6
R-20 (2 x 6)
5.5
32.7
30.6
1
.917
1
36.1
1
27.7
1
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