9709-118 (SFD)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.1•tc. 1213//97
Date . Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that'l am exempt from the -Contractor's
License Law for the following reason:
cam I, as owner of the property, or my employees with.wages as their sole
pensation, 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.G.,fo�athis reason,^,
Dater-'/ /I I,J14 -7 Signature of Own .
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.
• =Kqh, r L"A i ire?1'!
(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�abor
Vode, I shall forthwith comply with those, provisions. _
Date:7 r / Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I. have read this application and state that the above information is
correct. I agree to comply with all City, and State laws'relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property.for inspection purposes.
ti
Signature (Owner/Agenf),,�,^' a' Date >l
PERMIT# CONTROL# -
BUILDING PERMIT
.970941SX962
DATE VALUATIONjh'#� (� LOT 7 TRACT��� 3�
"C
ADDRESS .I°t :}bVYt!1v 1�E .V4%tt t,CA o
APN 773411-019
OWNER
CONTnACTOn /DESIGN En/ENGINEER + -
.'4kNILANIUK': CUMWAS
tw?WKEIR, f 111311,101E . `a',iITi,11 CXJHC
'73335SANII'fi. OSA.W.fl,Y'�11
45701 TVIO1<1W]t;'Ell S1l'1sv1
+v7C�l}3•! -;ii 57 � E3t:1!f
USE OF PERMIT '
P. -LAN
cur.(,x,Pc,)it'S 0t4GTv 1WH&S121a)'iiow75%fFag,titu"Tt is,D' -,giv4 i_;cam'
,.,3ArMJ, k41.AN `EVPP .
= W.v.-irt.[01141 nrr w
lqr
R: A it dt:'r1E3.i`1t a '.i' _526.00 818
R
.G'!:ilG't AIA'.q. is A:rD COST$ \I1?'-`M.LDNS.9,RU 35cOT"I'!}U'yso1v,40
MAN, VWC19 17R, 014*0-439-31. fi g i 1 f,.4a
Allectu"N'tcAt FEE 1.0.1.000.421-mr; M6._50
rut.:nulc m, i aa $iW09
PI,CJNIBINO r:�E $4200 .
R" l ONO Mf3`±'}E'}h pvl? -RF.MP ?f,11..fIN) 1?1a!»fiN.)
$Zum
41 F i{,A.3'1' ild i IC11 ,1: f'EN 22e.5^'W 0-4,VA-342
1'ctKt;:'Y:i1;:1"ILA-?t 10t-000-441-345 rfft
F
K
NQ F(
$2,7
t ES - PRE,P!!iaD PEES"
�O.QC9
NOW W
$217 3.ti
CA-,
v•
RECEIPT
DATE "?�;.,
BY
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
Compressor
Insulation /
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
D II - t. Lath
Final
Final a
BLOCKWALL APP OVALS
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 Lines
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
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:
THIS ATTIC HAS BEEN INSULATED T0:
This attic has been insulated to the It -value
indicated above, with Cocoon, the highcfficicncy
im%mlatiun. Made from a minimum of R(P/ rrryr•Ir d
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 It -value, the greater dic insulating power.
If you would like to add more insulation to your
home, contact your Cocoon authorized dealer.
RESIDENCE ADDRESS: �_ j A.
/r�r -- Ave. UQ 11 ( 6
L/a
I
BUILDER: 0 v 14( _�
CERTIFICATION:
This is to certify that attic insulation has been installed
in conformance with the covcc►ge chart recommenda-
tions on the opposite side of this card usingL/q bags
to covJQ5kSQ. ft. to obtain an R -value of 3-c
STALLE 'S AUTHORIZED SIGNATURE DATE
.,j• fat:'�:.. �.+�'. •''.""�"�• iM n�
.Ilnnr fuiNu'w7 //Ib
GREENSTONEpe. "
A LOUISIANA. PACIFIC COMIAMr
NOTE: 'Ibis vovcrage churl taolwnsa cs 6.r willing
and is lilt estill ding pugx.sl•s only. Sl:u.rl It -value i,
pruvidrrl by illmalling do. rlrplirl•d Illalls•r of lclgs
lar IIMMI sq. Il. m a minint I iomallvd ihiikovs...
Insall:ak"n 14 If.- I.rloin41 .11 IWr of It.g, may yield
nxxc dem 11x• sixr'ilwtl miniuuuu Ibi,'klxrs an,l minimum
1va•lgbl 1..•r s11. It. A, mal cImc ;ll;v will In• iolLn•ur1•.I
by job .vn limon, and apPliemon, t.•.'ImiyurS. and
may vary as nulvh as III!'. %volonn signif'ieantl�
alfcding the scucd It -value. Failure of the ineNllvr 1..
provide at Icasl the w,join-d nunlx•r of lull, ix•r
I(ltx) ml. A. and m lead Ole minimum thirkncs., luny
n:auh in a I-vr in.,IAWd N-v:du.•. 4:nmpacti.... ul..l.
1x'cur during inssdlalion.s Md v It -Nn. I.rp.irinl; uuue
Ihan Ow slalvd nunlbor of bags 1,. d -lain the
ulinimm�l installed lhickov-
GtoenSlono and Cocoon am hndmnanks of
GteonSlone, a Louisiana-Pacific. company. (9 1997
GteenSlone Indoslties, Inc. All nights tesonved.
Printed in USA. AV 70M 8/97.
8.97-TT7G-A
X4� �:Ir w � t�f' �•�
I ,
COCooll Slabili%cel Insulation -,
30 Ib. bas;
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
11 -value at
19.4
Net Coverage No Adluslment lot fnlsses
-
115.7
/S'f Mean
Mijul it
Co.!.Gun:. fuvrlagr. Ile :d on
Mmiot n NeI
30.6
tAininnuu Wriynl
lempelalme
thickness
2' r IC Im:;ses ml 16' owl'us
COvelAg!
1'el .`igume Tool
I.Waltad
Ito Wci,Ihl I'm
1. ohlain an
Insulation
Mwim IIMes
;gpia,r. I..ol Wflags
Nile,
e,lnl
Insutal,on
Snout Not Ile
S,laale feel
Itrqui,rd Pel
Illslall,
Sgoam feel
Pe, I,INJU
Ilesis4nxe. (111 n1:
Less IINIC
Pel 14x)
I.lt(KI swore fe.d
Insublia,
1•e., Hall
S,p,,xr. 1 eel
(incl.51
Shoual Not Ile
11:::; 1Wo. (Ills.)
R-50
13.5
20.5
48.8
1.464
21.3
415.9
R-42
11.4
24.4
41.0
1.230
25.15
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
8.15
32.0
31.2
.937
340
29.4
R-30
8.1
34.2
29.3
.878
36.5
27.4
R-24
G.5
42.7
23.4
.703
415.4
21.G
R-22
5.9
46.6
21.5
.644
!)1.0
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
n-11
3.0
93.1
10.7
.322
102.11
9.7
Sidnwalls Imessure filled -density 2.0 PPCFI -
R 13 (2 x 4)
r
3.1
r
1L4
19.4
1
1fS3
-
115.7
17.6
R-20 (2 x 6)
5.5
32.7
30.6
.917
36.1
27.7
.. +,
Desert Sands Unified School District41
Notice: .82-879 Highway` 111
Document Cannot Be Duplicated Indio, CA 92201
.1 619-775-3500 ' ,
CERTIFICATE OF COMPLIANCE
Date 9/26/97 - APN # 773-171-019
No. 16120 Jurisdiction . La.Quinta
Owner Name Coachella Valley Housing Coalition. Permit #.
No. 51885` Street' Avenida Vallejo Log #
City La Quinta zip 92253 Study Area
Tract # Lot # 7 Square Footage 1259
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 mobileho 'hes.
It has been determined the above-named owner is exempt from paying school fees, at this time due to the following.
reason: '
,w.
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 $ �2,316.56 the property, listed above and,that building.
permits and/or Certificates of Occupancy for this square footage in this proposed project may,
ay now be issued
Fees Paid By oc/Bank'of America/CV Housing Coalition ; � Telebiione 34723;1°57
Name on the check
By Dr: Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2;316.56 r
Check No. 2006711031
Signature nn
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 ?
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
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 ' t'
and/or executing contracts .with subcontractor's ,.,and/or -release of ,
liens and/or handling' liuilding permits relating to that certain real
property described below.
• All that certainrland located and being in the County of Riverside,
State of .described as follows: ,
LOT TBLOCK 59 OYUNIT 5 OF SANTA CARMELITA �AT VALE LA r
QUINT -A9 AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE,63 OF ,, 4
MAPS, •RIVERSIDE COUNTY RECORDS.
oJ
Armando Cuevas Miranda
-91 dVJ aQ
Date „ ` ` Gu-adaluprouriel-De Cuevas c
r ,r t