0106-014 (SFD)LICENSED CONTRACTOR DECLARATION
—1 hereby 'affi rim under penalty of perjury that I am' licensed under provisions of
C C 0
hapte ' r 9 (commencing with Sectio.97000) of Division 3 of the Business and
P'rbfessionals 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: from}
he
) 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
sal; (se`c. 7044, Business & Professionals Code).
as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Cci.d.B)
(•!)g,j'j am exempt under Section —, B&P.C. for this reason
Signature of Owner
p
WORKER'S COMPENSATION DECLARATION
1. hereby affirm under penalty of perjury one of the following Aeclarations:
I have and will maintain a certificate.of consent to self -insure.'fbe Workers'
compensation, as provided for by Section 3700 of the Labor Code, f6;r-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
ch this
permit is. issued. My workers' compensation insurance carrier & policy no. are:
Carrier 7 " MPT 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 i - f I. should become
subject to the.,workers' compensation prc.visi6n� of Secti6h 3700 of the Labor
Code, I shalltforthwith comply with thoseprovisions
Date- JApplicant— 1
Warning: Failur6 to secure Workers' Compensation coverage is unlaMul and
I `
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.in§p68tion..purp6ses.
?Signature (Owner/Agent) V 2
Date
BUILDINGPERMIT! PERMIT # 4 1
DATE VALUATION LOToio&014 TRACT J'
$88,381.10 13 2,11C 17 7
JOB SITE
ADDRESS
APIN
.'VI -995 AVIEWMA 0DRPGON
7-73,414_1026
OWNER
CONTRACTOR DESIGNER EN EER
IBRAUCKMA914 WC.
BRAUCKWNWOW
PO BWX 517
PO BOX 51°8
LA QV-Drl A C.A. 92253
JA QUUNTA CA 92231
C"Ruf zqnri +%f -
USE OF PERMIT
XG
SWOLF, FAW LY DW. 0T.L1
SPO - PERMIT DOES NOT INCL8, 'D9 BLOCK NVALL, POOL OR rim zwAy 1 0/
APPROAX14, (OV MASTER 1MA-2 PIAN)
TRiXT CONSTJR.UCTION -1,409 00 V
GAU.00VARPORT (SP5 i0, 172.40
5 FTI WOOD rRHIVE 200.00 LF
mv rnsu-r M. COW OF CONURUCTJ 0M
W,381 �1 0,
ypyy
VFX. NUMDI&ARY
CONSTRUCTION 1 U 101 -000-41 S -OW $00190
PIAN CHECK FER 101-000-439-318 $495.21
MRCH"ICAL MR 101 d)00-421.000 50
1ZLECTICICAL VERF 101 -OW-420-000
nummalu 101-000,419-000
STRO140 MOT1167)4 "r RMID 101-000-24I-000 $&24
ORAD010 FRE 111- JGO --- —1 $20.00
DEVELOPER iMPACT
PT WSE PLAN
FZZ DEPOSIT 42SOAD
Krille CTO PIANN C
$3.,4!4.50
D
D3S
42.50.0o
'1"'Alo MMITY.TV; DITHOW
RECEIPT
DATEBY
D T:Fl ALE
INSPECTOR.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
j
Set Backs
Forms &Footings
_
Underground Ducts
Ducts
Slab Grade i
f 3_ "
_�
Return Air
Steel !
:
Combustion Air
Roof Deck)
Exhaust Fans
O.K. to Wrap 7
l t.1e lt)
S
F.A.U.
Framing IJ
�ilC ;
6-2
Compressor
Insulation ;
�� �(8 t
s�
Vents
Fireplace P.L. i
Grills
Fireplace T.O. t
Fans & Controls
Party Wall Insulation I
Condensate Lines
Party Wail Firewall }
Exterior Lath
Drywall Int. Lath
-
i
J
Final
l � 77F Q, /
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs 1
Electric Bond
Footings I
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
O(
Heater Final
Water Piping!-�
✓
Plumbing Final
Plumbing Top Out t
Equipment Enclosure
Shower Pans 1
O.K. for Finish Plaster
Sewer Lateral
_ /_
��
Pool Cover
Sewer Connection
(�
Encapsulation
Gas Piping I
Gas Test
Vt.
/
IZ
Appliances ;
{
Final
COMMENTS:
I
Final—
Utility Notice
0
(Gas) j
ELECTRICAL APPROVALS
Temp. Power Pole !
Underground Conduit
Rough Wiring
Low Voltage Wiring !
Fixtures .
Main Service
Sub Panels 1
Exterior Receptacles I
G.F.I.
Smoke Detectors
Temp. Use of Power j
!
Final
Utility Notice (Perm) ;
Desert:Sands Unified School District
47 950Dune.PalmsRoad,,
Notice: - '��r , _
La Quetta, � CA 92253 ;
Document Cannot Be°Duplicat6d' 760771=851.5 ,
.CERTIFICATE OF COMPLIANCE
Date 6/18/01 v� APN# 773-3147026
No. .22134 Jurisdiction La Quinta
Owner NameBratickmann, Inc., Permit # 0106-.014
Ivo. 52-995 Street Avenida Obregon ' U. Log #
city La Quinta Zipr9{
2253 Study Area
Tract # BLK172 l.ot #: .13 Square Footage 1409 .
Type of Development Single Family Residence. No. of Units 1
By
Comments
At the present -time, the Desert Sands Unified School District ""dries not.: collect fees on ,garages/carports, covered
patios/walkways, resrderitial-additions under'500 square feet, detached`accessory>'Sir6*etur6s 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 APP'LICABL'E
This certifies that school facility fees _imposed pursuant to Govermm�ent Code. 53080 in the amount'of
2.05 X 1,409 or'$ 2;888.45 the -property listed above and -that building
permits and/or Certificates of Occupancy for this square footage in this proposed project maynow;lie issued
Fees Paid By CC / Valley Independent Bank - Mike,Brauckmann `Telephone; 760=409-5422
Name-on,the check 77
Dr. Doris Wilson '
Superintendent
Fee collected /exe ted by Annette Barlow
Signature
Payment, Received
.Check No. 247506
$2;888.45
VOTICE: 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 toDie Diatrict(s) or to another public entity authorized to
:ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a'copy of county or city plan check application form 'to.,disf ict''copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt •, Copy - Accounting
RR.. .. ....... ..... _........ ....._........:......_...._.__.__...._...._....... ._... _.__.__ ...__........... r.:...
1 10:25 FAX 17608049062 COMMONWEALTH TITLE
RE DING REQUESTED. BY:
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO;
William Thomas Buffin
Power Brokers.
B.O. Boa; 134
La Quinta, CA 92253
SPACE ABOVE THIS LINE FOR RECORDER'S USE
0002
The undersigned grantor(s) declare(s):
Grant Deed A.P.N. 773-314-026
Documentary transfer tax is $
( %,,)'computed on full value of property conveyed, or w:
() computed on full value less value of liens and encumbrances remaining at time of sale.
( ) Unincorporated area; ( ) City of
,and
FOR A VALUABLE CONSIDERATION, receip(of which is hereby acknowledged,
Yvonne Radice
hereby GRANT(S) to. WILLIAM THOMAS BOFFIN, an unmarried man
the real properly in the City of La Quinta Coijnty of Riverside
State of Califomia, described as
Lot 13 of Block 172 Unit No. Santa Carmelita at Vale La
Quanta, as per map recorded in Book Pages. »if Maps, Records of Riverside
County, California
Dated April 6, 2001 Signature of Grantor
State of California )
County of ) SS.
On before me,
Yvonne Radice
,personally appeared
Yvonne Radice'
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the person(s) whose name(s) is/are subscribed to the
within instrument and acknowledged to me that ha/she/they executed
the same in his/her/their authorized capacity(ies), and that by r
hls/her/their signature(s) on the Instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature
MAIL TAX STATEMENTS TO
Form 3196.4 (6-94) THIS FORM FURNISHED BY COMMONWEALTH LAND TITLE COMPANY
r•
Ms. Nickie J. Gormley
City, of La Quinta Building Department
78-495 Calle Tampico
P.O. Box-'1504.'
La Quinta, CA. 92253
RE: William T. Buffin
Dear Nickie:
Please be advised that the following-plans have been previously approved for use in the Cove
area of La Quinta by the'Planning Commission: William, T: "Tom°.,Ruffin=:has my permission to
use.the plans only at the following location:.
Plan Ba-1:r on
on
If you have any other questions; please ball ° me at 760/564-1866':
LEND TURES, INC..
President
APL:vI
City of L4Qui(nta
Y
Plan Cbeck Corrections
Date: May.; 4, 2001
Project Address: 52-995 Avenida Obregon
Project Description: SingleFamily Dwelling (and MA-2,master plan)'
Status: First review
Plan Checked 'by: Greg Butler (777-7015)
Dear Mr. Brauckmann and Mr. Lench,
Unfortunately, an error in previous approvals was,discovered today : ,The NIA -2 "Mesquite
Adobe" plan has an architectural feature that isnot perrnitted'by the La Quinta municipal Code.
The popout feature at. the Entry Door may not encroach mto.the required 10,foot street (exterior)
sideyard setback. As drawn; it encroaches by approximately two°.feet.
Even though this plan has been 'approved under the Master Design Guidelines by. the Planning.
Commission, I checked the approval documents, which:do not show the MA -2 plotted in such a
manner as to revealAhis encroachment.
Thank you,
Greg:
Respond in writing to. all corrections. requested below;::noting. where correctiori_can be found.
Return this list and all red marked, plans with• next -submittal. This will - expedite your back -check. v
Revise plans as. necessary; 'reprint and resubmit::two corripiete `sets •of plans, wet -signed by the
persons who prepared them. E
1. Architectural po;pout feature atEntryDoor may not encroach into the"required 10 -foot
exterior sideyard setback. Revise all.affected Plan sheets Drawings must be drawn'to
scale.
As further information is provided and reviewed, additional -corrections may be required.
END CORRECTION LIST
Page 1 of. 1
r
i
/ 7 A 11'
Gly
1-Ov4, c 0 c, .
REDISTRICT- PLANNING REVIEW
This form is ta,'be used by CDD staff for review of single.family dwellings in'the RC (Cove Residential)
District, in order to.determine'ihe applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall bet'ransmitted to`:thetiB.uilding,and"Safety'Department as your
correction list. Please attach additional explanations as necessary. joc,d s A 4 s rz� .7/4 /Z:g co IL
APPLICANT RRAUCKMANN, INC,*
SITE ADDRESS .52=995. Avenida Obregon
APN 773 _ 314 026, BIN NO.: CASE NO.: 0 2001-460
LEGAL: 'LOT 13 BLOCK
CHECKED BY. ; Wally Nesbit
-:' - UNIT } S.C.@V.L.Q.
DATE:
Inform the assigned Building plan checker upon your assignment -to -this case: The CDD Executive
Secretary, maintains a log book to track applications an&assign,case numbers.
REQUIRED .ITEM
Y •`.
N
COMMENT%CORRECTION
Compatibility Review
✓
.: '
Case logged and number assigned
1/
Verify legal and APN information:
,u
Consistent with MDG on file (as:applicable
t�l V1r -Vanrwc, e*r /nom LIs4- 1ZP11 }- 0WZ.I C
MDG filing required (5 filings-since'9/3/98) ,
Consistency with street/surrounding area:
RECVD FOR PROCESSING Colors
(DATE)
'ASSIGNED TO Materials:'
(INITIALS,) •
Architecture
?
YJ
SJie� y w.r /�s2 • �,aG
✓
' /'
Other Requirements:
Annroyed by; Q.
O Planning Commission ...
O City Council - _._.......�
Iommunity Dev. Dept.
ttials
.
t s,: r
,
74
xhibit. ... ,,..,.:....
0
ML1jVU rUM.MUGtbblft. 14'i / -
(DATE)
ASSIGN046% -
t -,(INITIALS)
Certific'a'te of.occupancy
City of La Quinhi
Budding and Safety Department
This Certificate.: -issued pursuant to. the requirements. of Section 109 of the Uniform Building Code;,
certifying that, at- the --time- of issuance, this structure was in comp/iance with` the
various ordinances
of the •City-regu/at ng building construction or. use. For the: fo/%wing:
BUILDING' ADDRESS. 52=995 .AVENIDA OBREGON; .
Use Classification:, SFD Bldg:. Permit No.: 0.10,6.-014
Occupancy Group: R3 `Type of Construction: VN Land Use Zone: RC
.Owner of,Building: BRAUCKMANN INC. :Address: PO 40X:;517• "
.City: LA QUINTA- CA ,92=253,
By: KIRK. KIRKLAND
Date: 12 -1'4 -01 -
Building Official
POST IN A CONSPICUOUS'PLACE