9709-119 (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
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:
'('lin 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,ezempt under Section B&P_C .for this reason _
Y Date . ;Y'" ,� �� Signature of Owiier-^^�
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.
QQ I have and will maintain workers' compensation insurance, as required by
S, don 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 a y �a y� 1 Policy No. ry� Y* 4 /°e�
1 Rt_1. � VNI JA!l:�AN.1 F Y0./.L'Hr 431'.4) y/V 114
(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
�ibject to the workers' compensation provisions of Section 3700 of the Labor
Code,,l-shalbforth'with comply with those proyis4o, s.
Date: ' 'V A.,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
/e above-mentioned property for inspection pur• oses. d
Signature (Owner/Agent)` ` Date
BUILDING PERMIT PERMIT# CONTROL#
pt>Ifq 5963
DATE VALUATION? �1��.� LOT �� TRACT Y�QEi 4ict%
413 014?,7
ADDRESS ,'f�:1 ����`.'.:'MjYii. �' �:lsi.sl'.,1a1�
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
K° .t 4'R
Nr"\se,e.A-,. sAwt . ♦.S .a, fie.. ,.'a�. .I
iYT �`VF°r! Nr'"t,Y ti:r(i
.. Yr �.r,u ,M, .1\ �, YA
4t
}b4;(f s tU,41 tVi;i6Fi
y g
i31 M4-)�Yt:l3j�
j 13 i.it.i (A OR01
4Ntad0 CA VZ201.
USE OyF� PERMIT
1114)_)
444o- is W(Mkt ive.)l 0o_'..L J0: ilm.i.A,'ti. tVA.A Zi ct4t PL"
( of ; 'k P rlt.N f)F 1,tvf, `IN't FOR N-101,T1111Jf I'S!.AJA141i t
Ae
TR& i.i, 4'S�4Mi3lbibd.%. 1l JE'M .�'. e,7�t.(JSS e!A'
k't..�a[ti♦4;fVPA1•.10 litfs.�ty�j Sr
�.►F1Gl���f�4t�71].',��.Y�.�' �iw17.L9V i/j'•
.%��'.�.w.�i4�iG�4���•',:; �4�".'l�"..�`�i. �.$�'Z'"��a�tFsryi�������i�;��`
7'i'w?�i'�.��v
ec�4� pp�� {{ �� �t� 7� {��
X?2f,K°Cl.,VN kEV, I0 4)(Vi-41131-000 ' s:w.9)
,n} q� rl•t€��f� �►;�� sit-ti�._as���i� �:�<l lsl
hf<1:+4` '1 a4: Al, V E�V; 10 i -00-42"W S I K3 r
PLUflttiNt} FF.,t t01-000-414-000 $ i`� i :5ti►
----;; QN(;�Vtc'yf'r�:?�iri:'F -RF`310 301,.fN3i}.'!.S}-llfiYi y7:rt,i
TSI x A.;°i'3f ;c' fib is VIT 22,S -OW -443-342 Si.*/..10.28
i�l2.fst'"1`;h,1'I,PI'�t 1t13••ti{)U•9E11a.�1� 5..3:4x►►
AND PI -�%NI-9 (Ik
'S°1,69S q0
LES -IN n1�1 1',�i f 1^ 's:;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
'
Ducts
Slab Grade
Return Air
Steel
A
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
S
F.A.U.
Framing
/
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D II Int. Lath
Final
Final
BLOCKWALL APPROVA 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 Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
ey
Pool Cover
Sewer Connection
0
Encapsulation
Gas Piping
Gas Test
pa b
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)
COMMENT/S/:
��� W GL D
Desert Sands Unified School District" ;
Notice: - 82-879 Highway 111
Indio,'CA 92201
Document Cannot Be Duplicated 619475-3500
,CERTIFICATE OF COMPLIANCE
Date ' 9/26/971 •4 " APN # 773-172-010
No. 16121La Quinta
f.
Jurisdiction
Owner Name Coachella Valley Housing Coalition ' Permit # .
No. 51950 Street Avenida Vallejo Log #
City La Quinta zip 92253 Study Area` .
Tract # Lot #. 15 ', Square Footage- 1210
Type of Development Single Family Residence. No. of Units 1
Comments
At the present Mime, the Desert Sands Unified School District does 'not collect fees on garages/carports, covered
patios/walkways, residential additionsunder 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 lime due to the following .
reason:
'EXEMPTION NOT APPLICABLE ?
This certifies that school facility fees imposed pursuani-to -Government4Code 53080 ` in the•amount of # „
k k
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 inthis proposed pr6je t may now be issued r
Fees Paid By oc/Bank of America,/CV Housing Coalition TeleOhoner- 347-1,157 ;
Name on the check ✓ r'y' r
By Dr. Doris. Wilson
Superintendent(la�•�'. �^ [[ ri.�ti'
Fee collected /exempted by Pauline Pearson Payment Received $2,226.40
Check No. .20067.110.311
Signature
DTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
bove will begin to run from the dale on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect them on the Dislrict('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city•plan check application form.to,district copy for all waivers. ,
Embossed Original- Building Dept./Applicant• Copy: Applicant/Receipt Copy Accounting
Ir
Coachella Valley Housing Coalition
r
{ k
Plaza 1, 45-701 Monroe Street, Suite"-G.`, Indio, CA 92201-
TEL:
2201 TEL: (760) 347-3157 FAX: (760) 342-6466
ATTORN9Y—IN=FACT AGREEMENT a;
I/We hereby appoint COACHELLA VALLEY. HOUSING COALITION,
and/or any of its. authorized agents as my/our attorney-in fact •for,the a
purpose of executing ariy,notices of completion, •waiver; of liens '
and/or executing contracts with subcontractors, and/or release of
liens and/or handling building permits relating to that certain real ,
property. described below.
i
All that certain land located and .being in the County of.River'side; "a
t State of California, described• as- follows: _.. -
LOT 15 BLOCK 60 OF UNIT 5 OF SANTA CARMELITA AT VALE LA.
QUINTA, AS SHOWN BY MAP RECORDEDIN BOOK 18, PAGE 63 OF
MAPS RIVERSIDE COUNTY RECORDS.
' "D ' K� �' � % - � �: • . S� c �/i9�Di2 �D/zc :y0 �� c �9.��1� • ��
r Date Salvador Moreno Gallardo '
• ', ..fes. .{ .. ,. ,� a n . r. ,
9t . } •{, ..,. — ':� `9F+: ,: .sc :x i'.: �:. l ►':+ -� ,•. :A �. A .F,F• E% Ii'' e�� '.(. �i {¢�
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3 i►ill?$a v-. L"zeZ' �'�� iry •r;�•:li.•t . �i~ �. y l"� ► ..
RESIDENCE ADDRESS:
!'_ �T& �,�3'>ws•>b >�s _..:�.:_ eta ri:LA
/4Ii ` .
i�4 •
INSTALLED
BY
xvTHIS ATTIC HAS BEEN INSULATED TO:
0A,4
BUILDER:
This attic has been insulated to the R-value CERTIFICATION:
the higli-efriciency This is to ccrtifv that attic insulation has been installed
indicated above, with Cocoon
insulation. Made from a minimum of 8(rX recycled
in conformance with the coverage chart rccommenda-
niatcrials, Cocoon is scientifically formulated
to deliver gmater efficicncy per inch thin other 'rd using9 bags
tions on the opposite side of this ca
insulation materials.
54". to coved.20
gsq. ft. to obtain an 11-value o6k.
It-value is a measure of resistance to heat flow — (lie
lie highcr the It-value. tltc greater the insulating power.
Ir
If you would like to add more Insulation to your
11 me, contact your Cocoon authorized dealer. mffALITHORIZED SIGNATURE DbE
r-.tt.'� ��� s►-�r' ;:ala y:•I:,'t '�;',y rIII�'.,i
�p
.y.y. 1T :••. ,:i!!_+1l 1,.'-��✓: -E'- - -i, j •fit-- r�+ .-'
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GREENSTONEpe.""
A \OUI$IAa A.1ACIrIC CO Aal
NO'113: 'ILis I:uvrral:c ch:u1 cungx•ns:ucs Ii., a.•ulinp
and is I:n cNiwaliu(; pugwlvs manly. Slalv.l Ibrduc i.
pluvidcd by insedling IIIc miniwd uelnl" * nl L:qs
(ace IrMNI mt. 11. :n a olinionnu insl:dhvl IIIi: kncs.
IIIMALalhal .d the mpliu 1 nuudw•r .d bags may civhl
uwttc Ilcm die s(xrifi t1 winink minimum
a•cil,ht Inv sq. If. AcInal ,vi -tag, will Iw• iulluonrrd
by j�.h .undiliuns. and :ggdi.•:uinn Irrbniyw .rod
.oy vary .I,. ..n.:1. .L. forth .vilbnw .ilpuilir.mdv
affecting the stmed It -value. Failnra-..1'IIIc inst:dler b.
provide m (cam IIIc rvyuhvd onmlw .d b.q;. p.•r
(INN) sq. 11. and m (cam it., minimmu Ihicknv.. mdy
wm dl in a II...... in.edled 11-c:du.•. Cnuq.a. Ii.... nl...
.mr d... ing in.edlminns ;da.vr H-311. Irquiliuf; nu nc
than the .simed number of baps e. obLnn Ibe
minimum iosiallcd tbicAov
GreenSlone and Cocoon are Nndintaiks of
GreenStone• a Louisiana-Pacilic company. q) 1997
GrcenSlona Indusbies. Inc. All riyhls reserved
Printed in USA. NV 30M 8/91. Sidowalls (pressure lilled-densily 2.0 PPCF)
Or
yyja1,7/.�J.i( 'tx��,� '�,,t� � ! �a ;, r, . �, j :;;�:•, , ,'�' ' f;. i t.: "; ,c.i - � ;
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(:<)Co (1'n SM1)iIiZCd IlltiUla) i(�11
30 III. had;
4f
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
N -Value at
19.4
Ifel Cmelafle No Adjusouem lim I 5ses
56.7
75'1 Mcarl
Minirmun
5.5
Gross Cuvanup: (lased un
M.14 ern Nei
.917
Mlutunun weilim
4.1pe.Ialure
Inickness
'r 17 busses un 16• udnc:
2ce
eomage
Vel Snuaie loot
Inslailnl
Ibe waoln Pe,
In Ilhlam alI
Insul'IIiu,I
Mmiunml Kim
S'Ir.un I.ao nl
naw; Itenuired
InSuhUon
Should Not Be
Sou-ve feel
Irequi.0 I"..Insughml
Inaalbal
quare l eel
I.... I.00u
IlrSmUnre (BI of:
Less Irian:
Per ILI()
1.81x) squve r eel
I'cI IM o
Square leer
(inches)
.;noNot fie.
Lass Than. pb::.l
R-50
13.5
20.5
48.8
---1.46,4
- 21.3
4G.9
R-42
11.4
24.4
41.0
1.230
25.61
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
.9:17
34.0
'1.9.4
R-30
8.1
34.2
29.3
.878
3G.5
27.4
R-24
6.5
42.7
23.4
.703
46.4
21.61
R-22
5.9
46.6
21.5
.644
51.0
19.6
R-19
5.1
53.9
18.5
.55G
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
8.97-TT/G-A
7,1 ,
17.6 �!
t
27.7 ?II
R 13 (2 x 4)
3.5
51.4
19.4
.583
56.7
R-20 (2 x 6)
5.5
32.7
30.16
.917
36.1