0011-177 (SFD)J
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that j --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
5,95754 D) C,9 - 0122
Date+<xSignature of Contractor =`
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
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
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C. fordhis reason
Date Signature of Owner
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 oft 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 STATE FUNDPolicy No. U-NI'.00110.."
(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.permitlis 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 Sect i �n 370df the Labor
Code, I shall forthwith comply with those, provisions. /
Date: "f.xcApplicant"ldr�, 6
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. J
Signature (Owner/Agent) Date f % {-
BJ'ILDING PERMIT PERM T#
DATE VALUATION LOT 00,1 4117 TRACT.
k 1t
JOB SITE
ADDRESS —425 AVIMfDA 013R.b.W301V
, 52
7�:+•.e�.aYij—�1�D
OWNER '
CONTRACTOR / DESIGNER / ENGINEER
1140..MAS WMIDT/A PAZ
Ptlz =1491FRI i' low CO
52-99,5 A4t.s`DW)AMINDO A
52•9951'w1111341DA2d—M, )OZA
TACUIWrA C,A, 92.253
LAQUINTA CIA 92253
C16L))564-3023 CMLN 5537,
USE OF PERMIT A
7OJ. K I?AMMY 23VYffi.I.d3 G
:4p) •;D09S NOT 1WCWf)I?' $1.Oi':>;*: W.P;. LJP0'`Y1BPP APP13'CACH
DRIVMMAY
T"kACi CONSTRUCTiOW 1,603.00 SF
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P RCN/PATIO 90.00 SF
0ARAa:1-C+/C"ORT (D) 9,074.30
91'!', 'E+J'JC'r01� PY�"fiIClS RQ0.811 1.Ja
wsmmik= cogn ar corr ntTc-&r; -
PERWr 7'F.1w bV€M.1WARY
MNSTJ R 1C1'10N RE 101.000-416.,000 $639.51
PLAN CHWK PUP
'1�13C°21A2�i1G,A.2. �i'YA:, 192 ^fi�30•�,8,1 n909 !&4`'t,Ot1
VXCTRICA.J..1f'1R10 $.Ol-BitTC1• 2�^f1(13 X1' 1;,97
PLUMBING P1>E 101-000,4119-000 $110.7s
STIZONO MOTION FFft.1t.F.SID 101-00.6-241-000 $9.91
41RADINO 1+" 101-000w423.009 imb.ft4
lr'Tt1':CISE PLAN 101-000-441-345 �10t�.fi0
101-.000.419-31£9'
SUB -TOTAL COM s,k U( -"110H At11r7PiAN Cl ''`1C
3 ft99.S3',c'
LTS30 FIRE-JWD F
42:0.00
TOTAL. PERM, I1q11K6D'Uffi11.N0W
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
J
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
- -B j
F.A.U. I
Framing
Aa. 0jS
Compressor
Insulation
. O
Vents r
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls t
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/- O — O
Drywall - Int. Lath
Q J. 7'
Final
c6�o S-7
Final
POOLS - SPAS
BLOCKWALL
(A—PPROVALS
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
Sewer Connection
2
Encapsulation
Gas Piping
Gas Test
. C)
Appliances
Final
COMMENTS:
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Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole „2 • / • O
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)
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rr w 4 r APPLICATION L
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Address - . � UINTA, CALIFORNIA 6'2253
~. OWn@(f r. art
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f� BUILDING TYPE CONST
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Address . * 4w a '..� ZJO.• �f: 4
A P Number`"1"t
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CityJ,:,1t ? �kr1� p '� �' ' f,�yi i Legal OesciiptiOn't1r
ntra for t ' Projekt Description ' 'tam f 'ALL Z QT
Address V F
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Zip .
Tel ;i
City.'...
City
S . Lic
8 Classif M Sq Ft:'. ' Noy : No. Dtlti
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Size Stories" `, Units
State Lic
Arch.; Engr '
Designer
New
Add O Alter D Repair D Demolition D
Address Tel. _
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Cit Zip State :
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that'I am licensed under provisions of Chapter B:(commencing with Section t
7000) of Division 3 of the Business and Professions Code, and'my Ilcense is In full force and.
effect. ,.:• .. .. ..
�rrun DATE :
OWNER•BUILDER DECLARATION " Estimated Valuation
1 hereby affirm that l am exempt from the•Contractors_License law for the following
reason: (Sec. 7031.b.&Wness and Professions .Code:'•My -eAy. or county ~ re uIres'a
permit to construct, after. Improve. demolish, of repair any. stnw-ft"; Prior, to Its issuance also .:
requires the applicant for such penM! _to fke•e signed statement that he b licensed pursuam ro PER :� AMOUNT
pn . .
me,provisbns of the'Contraeror's License Lew, Chapter B (eonanencig with Section 7000) of,
Division 3 of the Business and Professions Code._ or thaf.he.is exempt therefrom, and Me Dash - • ' y��e
rot me seeped exempfbn. Any , violation of section 7031.5 . oy "any applicant for a perms Plan Chk. Dep..
subjects the applicant to a Chir penalty of not more than fim hundred dollars (6500).
I: I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.' Bal.:'' `
do the work, and the structure is not Intended or offeredforsale. (Sec. 70#4, BuLsnssa and Const.
Professions Code:- The. Contractor'sUcenae Cew' hoes trot apply ro an owner, of Property w'�
buikfs or krprovae-thsr. and who does such work. hbnsed or-tkrolgh his own smPloyees Mech. .
provided that. such knprovements are not intended or offered, for sale ti,, however, the building
or krprovement is sold.witnh one year. of conloletion, the owner-bulldar. will have the burden—. Electrical
01 proving that he dict not build or krprove for the Pwryoss of sale J. - - ' :
HI, as owner of she property, am ezctuelvely contracting with Ilcensed contractors to eor►' Plumbing '" - •`'• t' Tj�
struct the project. (Sec. 7044, Business and. Professions Code: The Contractor's License Law _ `'-
does not apply to an owner of PmPeRywhO.bukds'or kmmves thereon, and who contracts for": S.M.1: _
.such projects with a contractors) licensed pursaint to Me Contractor's License Law:)
r` ' 'Grading
17 1 am exempt under Seca B. & P.C. for this reason .
Driveway Enc.
Fele owner tlnfrastructure
.. AA_
..
WORKERS' COMPENSATION DECLARATION
I hereby affirm tnat.l kava a•certificate'ot:;consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof.. (Sec: 3800, Labor Cade:) i .r• `. ' s
Policy No - ' Company
O Copy. is filed with the city cert)fied copy. Is hereby fumiehed.' `
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCEl
(This section need not be completed it Ore pemdt le for ons frundrod dollars fi 100) valuation.. .
or less.)
1 certify that in the performance oflhp'worktor whish this permit Is Issued, I shell not'�''� '
employ any arson In any manner so as to.become subject to the Workers' Compensation -
Laws of CaliPornla :
NOTIwner
CE TO APPLICANT.. If afror, making this certificate of .Exemption you shouid become ZONE: BY:
subject to the Rbrkere' Compensation provisions of the Labor Code, .you must ;rorthwd6'. - MlnimUm Setback Distances: -
comply with such provisions or this permil shall be deemed revoked.. -
Front Setback from Center Line
Rear Setback from Rear Prop Line`
CONSTRUCTION LENDING AGENCY.. :: Side Street Setback from Center Llne .,
I hereby at that there Is a.consfruction lending agency for the performance o1 the
work for which rola permit is issues. (Sec. 3097, Cha code.) Side Setback f tom Property Line
Lenders Name .. .. • . 4
Lenders AddressFINAL DATE INSPECTOR-
Th
NSPECTOR xR
This is a building permit when property filled out, signed and validated, and is subject to
expiration if wont thereunder is suspended for 180 days:• .Date Permit
I certlfy.that I have read this application and state that the above., Information Is correct `'Issued -by: '
I agree to comply with all city and county ordinances and state laws relating to building: •'
construction, and hereby authorize representatives. -of this city' to enter the"above. 311
mentioned property for inspection purposes Validated by: F
Signature of adplicant Date t i -.d 1 -.,>t ¢: '
Mailing Address Validation:
City, State, Zip
` WHITE = FINANCE :. YELLOW o APPLICANT PINK a BUILDING DIVISION
D sect.Sands.Unified"School..District
471950 Dune Paims"Road
Notice: La Quinta;.CA92253
Document Cannot. Be Duplicated ` 760-771-858
CERTIFICATE. OF -COMPLIANCE
Date 11/27/00 APN # 773-254-020
No. 21242 Ju.,risdiction`• La Quinta
Owner NameThomas BufWA• Paz. Permit #001 4-177
No, 52-425 Street ' Avenida 'Obregon., Log #
City La Quints Zip 92253 Study Area
Tract # Lot # Square Footage .1605
Type of Development Single Family Residence No. of Units 1
Comments
At the prese
nt time. the Desert Sands Unified School'District'. does' not collect"fees .on `karaaes/caraorts, covered
patios/walkways, residential additions.unde'r'S00 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from Oying school.fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to . Government Code' 53680 in the amount of
2.05 X 1;605 or $ 3,200.25. ,the property listed above and'ihat.building
r, 4 _
permits and/or Certificates of Occupancy -for tti s square footage in ihis'proposed project may nsiw be issued
Fees Paid By CC / Valley Independent Bank / A' Paz Tile tpone ;760-564-3023
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /"dabAnnette 'Barlow Payment Received.;." $3,290.257.1
Check No. 235009
Signature
you
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will. serve to notify that the-90Cay approval penod igy protest the fees or other payment identified
ibove will begin to run from the data on which the building or installation peril for this project is sssu6d or on which they are'paid to:lhe'District(s) or to another public entity authorized to
*Ilett them on the District('s)(s') behalf, whichever is earlier:
Collector: Attach a copy of.county or citycplan c application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
Oct -08-2000 04:13pm From -COMMONWEALTH LAND TITLE
RECOit =13 R>RQIMSTJM >AXl
CHICAGO TITLE COMPANY COMPANY
10313KC 207057344
WHZU RECORDIM XAIL T>SIS DNZD A=,
MMRSS OTHBRifrsE BROWN HELow,
>l6AIL TAX STATMOMS TO:
+ 3b
+7603418216 T-603 P.002/002 F-528
SZ. yZr �e
mcE aiONR gZA L=NE YOR RSCOADER's p8E
GRANT DEED "FX' 773-254-020
The undersigned grantor(s declare(s):
Documentary transfer tax y
(XXX) Computed on full value of property conveyed, or
l ) Computed on full value less liens and encumbrances remaining at rime of sale.
f ) Unincorporated area: ( ) CtLy of and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
ALLEN R. GREENWOOD and BARBARA R. GREENWOOD, husband and wife as JolnC cenanc9
hereby GRANTS) to
WILLIAM THOMAS BUFFIN, AN UNMARRIED MAN
the real property in the City of LA QUINTA, County of RiverxIde, State of Calllornia,
described as:
THE SOUTH MLF OF LOT 8 AND ALL OF LOT 9 IN BLOCK 11, UNIT NO. 1, SANTA
CARMELITA AT VALE LA QUINTA, AS PER MAP RECORDED IN BOOK 18. PAGE 46 IF MAPS,
RECORDS OP RIVERSIDE COUNTY, CALIFORNIA
Dated August 23, 2000
State of California
County of ) S.S.
On
before me,
personally appeared
personally known to me for proved to me on
the basis of satisfactory evidence) to be
the persons) whose name(s) is/are subscribed
to the within instrument and acknowledged to
me that he/she/They executed the same in
his/her/their authorized capacicy(ies), and
that by his/her/chair signatures) an the
instrument the person(s), or the entity upon
behalf of which the personts) acted, executed
the instrument.
WITNESS my hand and official seal.
Signature
VAZL TJJC 5TAT2XZXT9 TO:
Z/Z A OM'ON
ALLEN R. GREENWOOD
BARBARA R. GREENWOOD
(This area for official notarial seal)
6
SONCH 83MOd Nd9l: OOOZ A '130
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RC DISTRICT = PLANNING REVIEW FORM
This form is to be used by CDD -staff for review -of single family dwellings in the RC (Cove Residential)
District, in order to determine tfie applicability. of compatibility issues or need to require the filing of Master
Design Guidelines by the' applicant: It shall be'transmitted• to the •Building and Safety Department as your
correction list. Please attach. additional explanations as necessary.
4
APPLICANT Thomas Buf f -`n.
SITE ADDRESS 52-425" Avenida;..Obregon
J
APN 773 - 254 - 026. BIN NO.: CASE NO.:
1 _
S LE!�L OST BLOCK '11 UNIT. 1
CHECKED BY: Greg Trousd611 DATE:
2000-343
S.C.@V.L.Q.
Inform the assigned Building .plan checker upon your_ assignment to this case..
log book
The CDD Executive
0.*,4
Sec retaryaintains a to track applications and.assign.case numbers.
Compatibility Review
/Tt
Pe
QUIRED ITEM,
Y IN.,.
COMMENT/CORRECTIO
Compatibility Review
Pe
Case logged and number assigned
p
Verify legal and APN:information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings siince 9/3/98)
S
\
Consistency with street/surrounding area:
s
/
/�f e J Colors657.
G Materials
_ rchitecture
• �S _ -�
Other Requirements:
00
Certificate of Occupancy
POST.IN A CONSPICUOUS PLACE