9807-107 (SFD)U)
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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:
( ) 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
cbritractors. to construct the project (Sec. 7044, Business & Professionals
Code).
O
la xemp under Section B&P.C/' fo this rea on
Kate 2 Signature of Owne �C
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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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.
(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 pr vl ions of Section 3700 of the Labor
C�de, I shall f rt ith comply with thos�r6 cions.
�jate: � 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, 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 f Ins ection purposes.
ySignature (Owner/Agent) w�� Date
oY.?
BUILDING PERMIT PERMIT#
??f49i- 3 ui
DATE VALUATION LOT TRACT
?b%f ;5N2..S{J 72 r 1tut, t IS
JOB SITE
APN
g'TV�% y '
ADDRESS M-804 AVENWA i�A+AI.IERA
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1'0:.A&N.,CtI'V00f—%F,ifA1'
P.0.1401K 063 5
43- 701 FviONROE ST SIT 0
tei>r? (;sl €',A 922f-4
rl+DIO CA 92201
f9r` li 1=Z1i7 CALL
USE OF PERMIT
• c
ISj�
rN
S,4; ai.iiJ l ta�dlet, i'%.,iwri' i)GfiS NkYr �t�:;,'{:ti A!, BLOCK WAL,) S GR
i>43OL. PLAY E H�:iC.F! � ItLl�11(.dil� �:qf� Fi)i2 N4VL ))1.613, AIJC;I Cif ,��#�
t�t4ll+i� PIpAAI �f`1'P�. '
`1`3trlr: k %tSt•IS'['lil1 :fl .t� .1,302.00 t;.F
ftOtt ;:t0N11TIO 159.00 $F
i:hXI iVA1fC;ARP0"RA' 4.1`7.1+U ,sr.,
CCEN.4'rR,L ':I'10N FEE, (0)-NKI-418-000 ��E3Q?CI
MAN (1TXX FOE 101-01V-439418
MECI.fei2icCAL JJFG 101.000-421-000 1-10,50
E-,LEC1`tt:lCA VFXz ii>i.-000420-600 $1.1,9.41
NI.Cit Mi.NGF'IT! 10t-i10f1-41M00 $121.50 .
STtiOW-1 J+/rL?`I'TON r, (.: RESID 1.01-t►t}p-241-000 $8.219
r,
GRADING MT " 101-000423-000 320.00
I-WFA.A.`.ii`R,U C'UREVEL 2255-00?-44.1-'�9.2 $1,81812
PIRE'~'IS.E KA'N 10.1-{.? n-441-345 $ds.fff)
1 SMI—'{"(MA!, CONSTRUCTION J ND PLAN CHECK
F3 4. 6
LESS PRE-11111VID FM48
50.00
'>!'CKAI., PEttMITJi'UuSDkIll? NOW
$7,934.&:
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE 7
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
7
Combustion Air
Roof Deck
—Cc9 -
Exhaust Fans
O.K. to Wrap
4 —2— —q
F.A.U.
Framing .
Compressor
Insulation
!�_ Ji
Vents
Fireplace P.L.
Grills
Fireplace. T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Dryppll - Int Lath
�( 9
Final
Final Z51rz
BLOCKWALL APPROVALS
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
Pool Cover j
Sewer Connection
Encapsulation "
Gas Piping
j
Gas Test
6 �9
Appliances
Final j
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole S
Underground Conduit
Rough Wiring •:
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
`Exterior Receptacles
G.F`I.
fSrhoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)14 cj�L
COMMENTS:
T4ht
"
P.O. BOX 1504 APPLICATION ONLY
Buildingr 78-495 CALLE TAMPICO
Address �)'W� /7 V E, 140W M4 LA QUINTA, CALIFORNIA 92253
S is(.o 6ZUIN'TA N1 c.La 719,
Mailing
Address �, �s % 74,5
City Zip Tel.
ft) g2�SN
Contractor
d7c.fl N e?e erz-
Address
ty
State Lic.
& Classif.
Zip
Lic. q
Arch., Engr.,
Designer
Address Tel.
City (Zip (State I
Lic. N
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is In full force and
effect.
SIGNATURE — _ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, pdor to'its Issuance also
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
i.' . 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Il I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 amexemptunder Sec. B. 8 P.C. for this reason r. / �,/�
Date (!/ 1419 4-00viner i17Lo y er?—
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed i1 the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT., If. after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
ILDING: TYPE'CONST. OCC. GRP
Number T73— 1-75—CD3
Description
t Description'si_Att ,411 txA,402—
Sq. Ft.No.
Size 3® — Stories
New T,"_ Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW =.APPLICANT PINK = BUILDING DIVISION
Ell
►o
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/28/98
No. 17404
Owner NameCoachella Valley Housing Coalition
No, 51-800 Street Avenida Herrera
City La Quinta
Tract #
Lot #
Type of Development Single Family Residence
Comments
APN # 773-173-003
Jurisdiction La Quinta
Permit #9807-107
Log #
Zip 92253 Study Area
/ Square Footage 1,302
No. of Units 1
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
1.93 X 1,302 or $ 2,512.86 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project ma'y'-no,w,be issued
Fees Paid B CC/Bank of America/David Brudvik r '
,
Name on the check i ��
By Dr. Doris Wilson
Superintendent f
Fee collected /exempted by Juanita Green Payment Received $2,512.86
Z--� o ` Check No. 74" *.-,)60 a 9) (F14, 3
Signature
NOTICE: Pursuant of A3semby 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
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
collect 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
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/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 22 OF BLOCK 61 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.
at
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Pys/
-----------------
DATE
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FRANCISCO JAVIER QUINTANILLA
QSa--(2-U1201-ilfa
ROSA FLORES QUINTANILLA
June 24, 1998
Mr. Daniel Crawford - Inspector
City of La Quinta
Department of Building and Safety
78-495 Calle Tampico
La Quinta, California 92253
STRUCTURAL ENGINEERING CONSULTANT
54625 AVENIDA BERMUDAS. LA QUINTA CALIFORNIA 92253
760.564.0884 PHONE _! 76D.771.3606 FAX • WISH @ C W I A . C O M
Regarding: CVHC Plan 320 and 420 - Truss Calculations — Group 7 (Typical all La Quinta Projects)
Dear Daniel:
I have reviewed the truss calculations from Imperial Roof Truss which is to be used for the roof construction of the 3 bedroom and 4
bedroom homes in La Quinta. The truss calculations labeled "320 Plan" are for the 3 bedroom plan that is associated to the "96-051"
job number listed in the lower right corner of the architectural plans. The "420 Plan" truss calculations correspond to the "96-052" 4
bedroom drawings.
I have reviewed the truss -calculations to confirm the capacity -of all design loads drags and bottom -chord loaded girder trusses. I have
found each to be in compliance with the intentions of the structural design I have also verified that the roof dead loads used in the
design of the trusses exceed the design loads on the structural calculations. The truss calculations are more conservative and therefore
acceptable..
The Truss calculations will be used the self-help La Quinta Project - Groups 4, 5, 6, 7, 8 and 9. Each group will use the same plans as
those mentioned above that these truss calculations conform to. I have provided a separate letter referenced above for each group.
These are intended to simply the City's records and allow a separate approval for each block of homes. Coachella Valley Housing
Coalition can provide the addresses for each lot in each of the groups listed
Please contact me at your earliest convenience if you should have any questions or additional requirements.
Sincerel
De s S. Wish PE
Structural Engineering Consultant
t oIfESS;
`� CEi,I�'IS S. I✓ISH
NO. G041250
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3-3 CA 1/
STRUCTURAL ENGINEERING FOR - CUSTOM HOMES - REMODEL - COMMERCIAL - LIGHT INDUSTRIAL - SEISMIC RETROFIT 8 REPAIR - UNREINFORCED MASONRY - RETAINING WALLS 8 FOUNDATION- REPORTS:
DAMAGE ASSESSMENT - NEW ROOF - INSURANCE CLAIM - DENNIS S. WISH P.E. HAS BEEN A MEMBER OF THE STRUCTURAL ENGINEERS ASSOCIATION OF SOUTHERN CALIFORNIA SINCE 1983