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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 $2,226.40 Check No. .20067.110.311 Signature DTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified bove will begin to run from the dale on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to ollect them on the Dislrict('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city•plan check application form.to,district copy for all waivers. , Embossed Original- Building Dept./Applicant• Copy: Applicant/Receipt Copy Accounting Ir Coachella Valley Housing Coalition r { k Plaza 1, 45-701 Monroe Street, Suite"-G.`, Indio, CA 92201- TEL: 2201 TEL: (760) 347-3157 FAX: (760) 342-6466 ATTORN9Y—IN=FACT AGREEMENT a; I/We hereby appoint COACHELLA VALLEY. HOUSING COALITION, and/or any of its. authorized agents as my/our attorney-in fact •for,the a purpose of executing ariy,notices of completion, •waiver; of liens ' and/or executing contracts with subcontractors, and/or release of liens and/or handling building permits relating to that certain real , property. described below. i All that certain land located and .being in the County of.River'side; "a t State of California, described• as- follows: _.. - LOT 15 BLOCK 60 OF UNIT 5 OF SANTA CARMELITA AT VALE LA. QUINTA, AS SHOWN BY MAP RECORDEDIN BOOK 18, PAGE 63 OF MAPS RIVERSIDE COUNTY RECORDS. ' "D ' K� �' � % - � �: • . S� c �/i9�Di2 �D/zc :y0 �� c �9.��1� • �� r Date Salvador Moreno Gallardo ' • ', ..fes. .{ .. ,. ,� a n . r. , 9t . } •{, ..,. — ':� `9F+: ,: .sc :x i'.: �:. l ►':+ -� ,•. :A �. A .F,F• E% Ii'' e�� '.(. �i {¢� ��. t ' . � �, ,y �- - ;� .t �, ��i, :: Y ,. ; .1�.. •e3 'L.. L.1��.•odri :. ��.-- ••�''l�i� ��?.j 3 i►ill?$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�+ .-' u'i •j'� ` 1 'fir _ a:1 4�. .9 " �l ' ,{ S ;#' .-- `, P.. �.fl � .0s;i^ M1 VF .f b `A� •i TM J .Ilnwjrrrund /7r 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 - � ; i;r X11 rZ:I)�/}�'' j"'��' , �f.��M'� f`'•�•�n,��:`. ', JL ....'�. T' 'f.,r,,, w,�. 'd�" .t`. �, ,7`•� •�: (:<)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