9709-119 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
1-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c�1 W Professionals Code, and my License is in full force and effect.
LU
O Z) cM License # Lic, Class Exp. Date
r-- CYLO .7k.
LLI
oZ ti Date Signature of Contractor
�O�
J U 0 OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z_ (A 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).
( ) 1, as owner,of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
CY)to
O I am exempt under Section B&P.C.-for-this reason
O N Y Date Signature of Owner
rn
< WORKER'S COMPENSATION DECLARATION
C) z I hereby affirm under penalty of perjury one of the following declarations:
r Qtr
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work'for which this permit is issued.
Q () ( 1 have and will maintah workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
rn permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
aCo
Q (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 the Labor
,'Code, I shailtforthwith_gompiy with those.provisio t
v� Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above -mentioned property for inspection purposes.
I
;1 Signature (Owner/Agent) .._. Date
PERMIT# CONTROL#
BUILDING PERMIT 1 I•� �; q
i
DATE VALUATION % LOT TRACT ,•,
JOB SITE APN
ADDRESS i '. ii ■ i .Y I I !.I i1-x I ..e[ 1 i • .x ) .: tI 11.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�_ ,•• 11 ,,y ,�. .•'.. ..�i' .,,I.IR
,i4; n,� I` �y�:i, ��, tz %VL, 11, 1•I.
�. I�,- FtV •. �
� ;Ir} f�jt .tei;l 1}; .,1 :yl l•„
P. •1I+1
1 in r
USE OF PERMIT
. -! s •+ ;t ;Y+,� I I+u1 1,1 'I 'h IA.' P$ A Jv %I L..} +I i'- •. '+ i'7
I to.. :. } ! 1•I•J•'; v1-1 A it 1.1 P r'av , I•, o11 Nil FI I If'i -I. V.:A lid
+iAk:\a.T-.-{'Ail i" ,It I'
N'I'PI II,1.}r IN +.: r 101 t;rut 4WAKY1 .1J1
€+1 AfJ I'411=1"I• I.I r 11114lfN).Xv). 118 At 1.1 +11
VI ID •01H: 1`C (1Ih]
4' r_i.. 10 i -lRlli• t,.%-(Jiw
4'1.,IrAIt311*4F•i•J, iill-fHl13-.110.(K1sl
�+ ].Si7 lLii!'{'t, ►iv F1tF- i11 1111 •()(1V1-".11 .(ux! 1-s
+►ii.Ll)I.iytTZ'I:�: If3! (]t}[3 i?�-(HH1 T:11,k.+
Ih43.bCl�::"rj{1,4 1Oki.
PRI.t+'Vit• 0 AN 11);-fit-0 t'iI ;,h t
NIlit 'n V1,11 I`tN.,IVIA fi[Iti: •1AilIF'I ��t"Iif�'1,
„
.l .,.. i iti. I 5,1 � i .-I.•.•
!,."I•.�:
!t>I li Ir'VIVifl I. AI•rs 011V Mow
�1,�r■1�*!fi
!1.
RECEIPT
DATE B y DATE FINALED
INSPECTOR
INSPECTION RECORD
INSPECTCR
RA C ON CTC-R
OPERATION DATE
DING ;4FIPROV; ��"s,
I PA
Set Backs
r70rMS& Footings
Slab Grade
Steel
A
Underground Ducts
Ducts
Return Air
Combustion Air
Roor Deck
Exhaust Fans
O.K.to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace F51.
Grills
Fireplace T.O.
Fans & Controls
party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
0 rail Int. Lath
Final
Final
a W, ffh
Id
POOLS - SPAS
BLOCKWALL APPROVALS
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
Waste Lines
Gas TestElectric
Final
Heater Final
Water Piping
-A,
Plumbing Final
Plumbing TopOutEquipment
Enclosure
—Shower —Pans
O.K. for Finish Plaster
'—T&;;r —Lateral
i
Pool Cover
Sewer Connection
0
Encapsulation
_Ns- —Piping
Gas Test
_Appliances
Final
COMMENTS:
Final
Utility Notice —(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
7
Underground
Underground Conduit
Rough
Wiring
Low Voltage Wiring
i—
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
1
1
Utility Notice (Perm)
141
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/26/97
No. 16121
Owner Name Coachella Valley Housing Coalition
No. 51950 Street Avenida Vallejo
City La Quinta
Tract # Lot # 15
Type of Development Single Family Residence
Comments
APN # 773-172-010
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 1210
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
1.84 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 now be issued
Fees Paid By oc/Bank of America/CV Housing Coalition Telephone 347-3157
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson
Signature
r `
g �-
Payment Received $2,226.40
Check No. 2006711031
10TICE: 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
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
tilled 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/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 15 BLOCK 60 OF UNIT 5 OF SANTA CARMELITA AT VALE LA
QULNTA, AS SHOWN BY MAP RECORDED IN BOOK 18, PAGE 63 OF
MAPS, RIVERSIDE COUNTY RECORDS.
8',;2?'&�7
Date
Salvador Moreno Gallardo
THIS ATTIC HAS BEEN INSULATED TO:
This attic has been insulated to the It -value
indicated above, with Cocoon, the high -efficiency
insulation. Made from a minimum of 801% recycled
materials, Cocoon is scientifically formulated
to deliver greater efficiency per inch than other
insulation materials.
It -value is a mcasurc of resistance to heat flow — the
higher the It -value, the greater the insulating power.
If you would like to add more Insulation to your
home, contact your Cocoon authorized dealer.
RESIDENCE ADDRESS: ( %
INSTALLED BY
Tom; C7F�
BUILDER:
CERTIFICATION:
This is to certify that attic insulation has been installed
in conformance with the coverage chart recommenda-
tions on the opposite side of this card using bags
to coveN=�sq, ft. to obtain an R-value of3k.
N,
*INALLER' AUTHORIZED SIGNATURE D TE
+r��:�t�' a� 4.'It^'Ik► i r .1'q� ( !' >• e6t,
�ti,•1
�i � •r' I lT t, • � �
4`rr'I 1 F
��i�•r f'�..'IY'� -y 1 1 �y ,
r'
(;cW0011 StahiliZIUCI IlltiUlatil)Il
30 Ih. hag
,Ilurlufircrurwl llP:
GREENSTONE."'"
NOIT: This ctweragc than cuuyx•n.ale. hn x•nling
and is li,r eslinmingl IHigwrvcs Holy. Slated R.,ahle i.
Precickd by inslallinp• the ri•quilcd nuudn•I nl h.q;.
Ixr II srl, It, :d a Ininiouit installed Ihi,kuc..
Ilt.4.111I ,H dx• I1 mull nl' bags w:n' ya•Id
nwre Than the.Ix•eigw•al Ininimunl this k-, alxl eom....nu
sveil,lo Per mi. It. A('Itcd a ver•.q.e will Ix- inlluen, ed
hp jib rnnditiun. and .IPPli,alinn Iv, hni.p.v%..,nd
clay- valy a, ouuh a.. lip.;. ,vide nu .iBnih,.unh
affecting the suned N-value E.ilurc nl the imiallel In
pu n•ide at le:lsl the required ouedx•r nl b.gls Ix•,
i IIHH) sq, h. and at least the minimum dlieknc.s n.ly-
lc.ull in a Itru•1 iu.ndlc,l II-, ❑lur- C..o,I..I,1 n,.1%
1"cur during! in.malldtinn.. .dx,vc H-M. lequilin); nu nc
Ihan the Stated nunlhcl ul bags In nb41111 the
mininlnln installed thickness.
GroenSlone and Cocoon are. Iredemarks of
GroenSlone, a lonisiana-Pacific company f) 1997
ATOMIZED PNEUMATIC APPLICATION
COVERAGE CHART
II at
Net Cltvelall. No AdIuMotenl lot Iw scs
751 111.
Mxomimr
Gross Commie Ilred nn
II ino Nei
Mnnuuml Wculhl
TemlkMlme
INickness
2-.fi Imsses uu lh-G•nhvs
('.overage
Per Squan: too[
Installrsl
the Wcodd Per
In OHLon an
WWI'hold
Ins Allow
No, Be
Sgnare grfeelMuu:ol
BI
It,, trol pp..Inslancd
SW " tool of
FAIIII I "I
Balm. It .1 I
P.-I 101R1
Ilesislance (R) of:
I em than
Per Wo
1.000 Sgove I rcI
Insolahml
lit III
Square I rcl
Iilx;hrs)
Should Nor Itc
13.5
�20.5
I ex I hall I lhs )
Y1-4G4
11-50
48.8
21-3
413.9
R-42
11.4
24.4
410
1.230
25.6
39-1
R-40
10.8
25.6
390
1.171
26.9
37.2
R-38
10.3
27.0
37.1
1.113
28-4
35.2
11-32
8.6
32.0
31.2
Y
34.0
29.4
R-30
8.1
34.2
29.3
.878
313.5
27.4
R-24
6.5
42.7
23.4
.703
46-4
21-6
R-22
5.9
416.6
21.5
.644
510
19.6
R-19
5.1
53.9
18.5
.556
59.5
I G.3
11-13
3.5
78.8
12.7
.381
87.0
11.5
R-11
3.0
93.1
10.7
.322
102.8
93
GroenSlone Induslnes. Inc. All rights reserved
Printed in USA. NV 30 Sidewalls (pressuro filled -density 2.0 PPCF)
.•L-.a - ti
�r r s^1! wlr-r-rrr.--r•�rar��rr+sn>t
13 (2 x 4) 3-5 51.4 19.4 .583 56.7 17-6
20 (2 x 6) 5.5 32.7 30.6 .917 36-1 27.7