9709-117 (SFD)I?
LICENSED CONTRACTOR DECLARATION
y` o:.r, I1lereby affirm under penalty of perjury that I am licensed under provisions of
'I—. Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 U) W Professionals Code, and my License is in full force and effect.
_M License ,# 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
L_ igense 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to .construct the project (Sec. 7044, Business & Professionals
Code). _
�) I am exe pt under_Sjection B&..PSC for•"this reason a
Date I % +'/ 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
pert rmance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
,8eclion 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.
RUCK, Mfv(A�ANICU .4 AW,14370 00 96
(Tris 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
�0 bject to the workers' compensation provisions of Section 3700 of the Labor
Code;'°I''shall forthwit comply with.those: ovlisions.
Date: 'r` s J �' � %pplicWant " ' '"
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. t it.{
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
thg9nstruction, and hereby authorize representatives. of this City to enter upon
e above-mentioned property for inspection purposes.
Signature (Owner/A ent Date
PERMIT # CONTROL #
BUILDING PERMIT 97104..11=1 5959
.
DATE VALUATION % 1,16 Z LOT tj. TRACT Ulm) Vi.i)SJOB
SIfE
ADDRESS �g ah X 44/a!,t�l.ilLl� ``r.'auvic)
APN 77.'f<b7�1• .A "
OWNER
CONTRACTOR/DESIGNER/ENGINEER
��"#�aeis�i.�Ji ii-Wi i i'enivro+
xa ier:Y'eiL + siiii
Z- 5W9 i D.Oi;:+= NOOP,
;Iyifi 'MONWE 1�at'�" E it
INT IO CA, 922Dt
IeNDIO CA. 9:d701
i 760)347_.A1 7 t,tlTr�f
USE OF PERMIT ..
t r�;5�st J t l O )x � ry A t�Si`l UDL IAL C K W As.L C,,R.irCOL. 19LA
UA�:. ii3;L:i#'ii,',r'iG+�i,^3.CF:d'rii.
PORC'4.L':Ps ilto SI:
{f1i7.41.4�if*lt:;r112,1'rJK't' $la�:t)%j :31�
jsr-w o.) cosr tpr)mnLCrio,r_
:7,369,28
PERMITpCE.WNiTAy)
.
d,:C3Nnit1:,(1_'.t0N EL101-WO-418-000
V'4IN- d�(1nM�-
i' V:*,01i1•i.4'�i a`AL FEU I oil -OnA-4121 1 -000
13wE C`R.1CAL FO, S f. J 6 37
l�tC�+'��iM1N�'C''.Gsi 1E3.� Qtifi-•1l9Eid)O, �1Mt,�t�
7Ts?«ays.t.tvir�i`.t��? f:t -PERSID '101-100,.'24t4w 57.74
WtkA:;i'I:.t,it:T01d;FE-E 22.E -443-342 b4,7t.u.kJ
F+kEr,".'ISB KAN 11014)P30-441-345
T(i A,1,.,Pf,,F•i1MYf FEF,S 6?UK NOW
2tiG►H5.±14!
RECEIPT
DATE L
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel AI
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U. v�
Framing
Compressor
nsulatio
Vents
fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath a
Drywall - I . Lath
Final
Final
BLOCKWALL APPROV S
POOLS - SPAS
Steel
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 LinesHeater
foe
Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 7 0
Encapsulation
Gas Piping
Gas Test 2a�o
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:
Desert Sands Unif ed School District
r.
82-879 Highway 111 4
Notice: •. '
Document Cannot Be Duplicated Indio, CA 92201
619-775w3500-
CERTIFICATE
19-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/26/97 APN # 773-171-018
y •
No. 16119 `Jurisdiction La Quinta 3
Owner Name Coachella Valley Housing Coalition f Permit #
No: 51865 ( Street Avenida Vallejo ; Log #
City La Quinta• s . zip 92253 Study Area
Tract # : Lot #. 6 .. , :..Square Footage 1,210
Type of Development Single Family Residence No:.of Units 1
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
1.84 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 n`olw ,lie issued
Fees Paid By co/Bank of America/CV Housing Coalition, Tei phone:u347-31.57
Name on the check r_ �� •?;
By Dr. Doris Wilson`
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2;2216.40
Check No. ° 2006711031
Signature �t Aa K3N�Q �QA).AA /V,—
OTICE: Pursuant of Assembly 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
bove 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
ollect 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
r
X
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 1,210 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 n`olw ,lie issued
Fees Paid By co/Bank of America/CV Housing Coalition, Tei phone:u347-31.57
Name on the check r_ �� •?;
By Dr. Doris Wilson`
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2;2216.40
Check No. ° 2006711031
Signature �t Aa K3N�Q �QA).AA /V,—
OTICE: Pursuant of Assembly 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
bove 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
ollect 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
r
Coachella ,Valley Housing Coalition i : -
Plaza 1, 4S-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 6. BLOCK 59 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.
THIS ATTIC HAS BEEN INSULATED T0:
This attic has been insulated to the 11 -value
indicated above, with Cocoon" the high -efficiency
insulation. Made from a minimum of 80% recycled
materials, Cocoon is scientifically formulated
to deliver greater efficiency per inch than other
insulation materials.
R -value is a measure of resistance to heat flow — the
higher the R -value, the greater the insulating power.
If you would like to add more insulation to your
home, contact your Cocoon authorized dealer.
RESIDENCE ADDRESS: . -,fi
"5-/- Ave.W WWI, 4 1
BUILDER: V
1
(714
CERTIFICATION:
'This is to certify that attic insulation has been installed
in conformance with the coverage chart recornmenda-
i
tions on the opposite side of this card using bags
•~R �
,Ilnuofilelunvlllr• -
GREENSTONEre' "
_ • 10 Y1.1•M••�•CIf IL Co.,..,
N(fl):: 'Ibis ruccr;.w dmil c,onI wosatcs tier .a-Illiog
and is lily cstinuuinp pugw na•.v only. Stmed It-a'alua• i.
pnlritMd Ity i islalling the rrrlui -d mmnlw•r ..ILaps
par 14NNI .1. li. m a motion I inslallcd Ihlekna•ss.
1-1-01blh•I ad 1-- mloiml in nml- .d Wit, may )h -hl
nit we lhan IIk•.q><•rilhrl Ininiulunl Ibh'klw•.cs:onl oriniol It
a•a•iphl lw•r sq. It. ,Lrioal duvrr'apr will In• intturorrd
by p.b roudirinus ;nut :ggdir:niuo Irrlwignrc.:oul
may vary as ....tell as IM, withuul siynitirandy
:411'et1inp doe sImed It -value. Pailinc of Ihr insl:dlrr to
provide :u Ica.m The requir-I nuudlt•r .d hq;s I.-l-
1000
e•r1000 sq. It. and m Ivasl do- minimum Ihirknrss ow).
renuh in a loam in.matlr.l
alra'ur during llimall:aions :dswr R-111• lavp.oinp mo...
Ilmn Ihr slala•d nuodwr of baps b. uloain Ihr
minimum installed Ihiekuees.
GroonSlone anon re.
d CYeoaNein"" ills of
GrooeSlone, a Louisiana-Pacific.. company. (9 1991
Gleen
Slone IndusNies, Inc. All rights iesnwed.
Prinled in USA. (IV 30M 8/97.
8.97-TTIG-A
TV
Cocoon Stabiliziud Insulation �-
30 Ib. bas; '.
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
A -valve at
Nei Covetane No fo+loslulenl Int hos:xs
151f Mean
Mininoon
Cnc::. Cmelane ILea:'I on
Kim I Nrt
Min We.141.1
lempetalme
Ihicsness
2' a 1: Imsses on 16' Ceohas
Covet•lge
Pei S,I,m,c fool
Installed
Ilm Wchihl Vm
In Ohtdtn an
losoLUmn
Mininuun 14t4s
SIW:nr. Wol of
flags Nen (I
K.
Insulation
"),if:
Should Not fie
Squaw fort
n.:4uirLd 1'ry
Installed
Squan: feel
1.4141
Ilesist.-it III
Less IWo:
I'm 0.u1
1011115111cttC lrrl
InsoWinn
pet Iky1
Squnr. Irrl
(UILI.P.5)
Sleul4l WI It...
1 rss Ilnu.: plc:.t
R-50
13.5
20.5
48.8
1.4G4
21.3
416.9
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
:14.0
29.4
R-30
8.1
34.2
29.3
.878
3G.5
27.4
R-24
G.5
42.7
23.4
.703
46.4
21.6
R-22
5.9
46.6
21.5
.644
51.0
126
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
27
rq.} 'f j1
1 .I
E• 'I
Sidmvalls (pressor.. litlrr4drnsily 2.0 PPCA) <
R-13 (2 x 4) 3.5 51 A 19.4 .583 56.7 17.fi
R-20 (2 x 6) 5.5 32.7 30.6 .917 36.1 27.7
{� i..l �, ;i•.''!. '+'.1 gyp:.. pi1�.+(• ..,
1