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0201-046 (SFD)LICENSED CONTRACTOR DECLARATION sl 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 /Y-) X31 C9 ff 00317/2c /Date Signature of Contractor,R-�- ., a 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 contractors to construct the project (Sec. 7044; Business & Professionals Code). O I am exempt under Section B&P.C.-for this 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-ingure 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. JI I have and will maintain workers' compensation insurance, as required by Sxction 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. ATE FUND a29-a:AUMIT 001love (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 Sectiol4 3700 of the Labor ,Code,;) shall forthwith comply with those provisions. Date �t 0 s 102 ZApplicant / 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. Signature (Owner/Agent) Date4lf y i BUILDING PERMIT - PERMIT# DATEJ VALUATION LOT Q201- 6 TRACT -Ly 1 l I) :kd34, J'7" P-11. 2611 JOB SITE' APN ADDRESS 54 -WAW, A GB F G( -),ST '774-274-00-7 OWNER CONTRACTOR / DESIGNER ENGINEER F.J arwO7+7. PP tMy/Vpao;� o 1:'O DOY 134 :b A,Ql•1i2Q1'.1A CA 1'92251 LA.Q iINT:TA CA 92253 (76,0)564-3023 C"f vil 5537 USE OF PERMIT 5U''D- HMO :0Ob+:5l NOT M10,01f L'IOt' X "si��1:1..5, P001, Oft, 11']?JVZVrAy TltACT CONSTRUCT160 I'ZI OO 3F laOPC:t#P,f VO. 56.60 V C ARAORMaRPORT 49.0,00 SY CONS RUIC'TION FP't9. 101-000-418-000 5657.00 Pulkw CHECK 3FMI 101-000-439-318 $13533S FE E DEPOSIT 101 .0100439,iM 4250.00 li9LC'33ANI AL 1+`XE 101-000-1-21-000 b %'3,00 r�L,@?P.RlCALFk"2 101 1000-112 "000 $:11.x.29 PU 1d1MO ITZ 101-000-419-000 $142.00 STRO). O M0170N 1FE - "A;. MID 101 ails W441 -000 $10,49 ORA,t IHO;'x'1;.3?• 101-000-423,000 $-". Ott DEVE10PER IMPACT FEE $1,007.00 4, .�..... i.Y'Fs-°f°tyT'�,is.,C')Vff�']�L1t;,;`3l`.tC3:tdAl J1i .1�7.�+iXCIMICIR (fy (rl JAN AL MIMM XT SM' HOW 810 0 3 114 2.1.1. 1 1002 crry R: RECEIPT DATE` _ BY / DA ALED INSPECTOR 4 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION T DATE INSPECTOR BUILDING APPROVALS' MECHANICAL APPROVALS Set Backs — vZ Underground Ducts Forms 8 Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap F.A.U. Framing Z p i. Compressor Insulation • 0 Z Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath ' Final Final o POOLS - SPAS BLOCKWALIL AP ROVALS 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 - _ p2 Heater Final Water Piping it Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral 144 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test •��, 6 Appliances Final COMMENTS: 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) C py 9tiAsr '1 '[ i !� �s 1l frr I .7�{�S{•""..•,rw.-o.+.-...a.► ••.R'-r,�.s'• � A 'y+➢y.+i�e�'. t� ` n P.O. BOX 1504 Building 78-495 CALLE TAMPICO APPL IOMPIL?' 7 2001 i Address 54 44 o Ola (2 eee,, in N LA QUINTA, CALIFORNIA 92253 Owner 0 3.0 " Oy 6 CiiYOFLAQU.l7A Mailing BUILDING: TYPE'CONST. OCC. G Address P c) tyQ --7 Q A.P. Number r-, 0:1 City Zip Tel. T t N r _� 1 r � rl, C � 7 5--k56, Legal Description �� Lc�r Contractor Project Description �� . i1 .2 _R4, -P-4 LaLiE Address �� Mi✓/Jno-Zn. iD I Tel. kh (Dutu4i. I9 L -7_<, '7.'Coi- 2 State Lic. City & Classif.� t Lic. k Arch., Engr., Designer LC�� y Address Tel. City Zip, State orr' �Lic. q 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, alter, improve, demolish, or repair any structure, prior 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). 1' 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.) II 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.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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. 3900, Labor Code.) Policy No. Company C7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if 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 Ihereby 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 it work thereunder is suspended for 180 days. I certify Ihat 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 -of this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date .Mailing Address City, Stale, Zip i Sq. Ft. No. ' No. Dw. i Size �(� 3j Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ 1) 4TAas„ Itimated Valuation PERMIT AMQUNT /e / 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: Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Permit Notice: Document Cannot Be Duplicated 9 Desert Sands Unified School District 47-950 Dune Palms Road. La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Date 1/11/02 No. 22830 Jurisdiction Owner NameThomas Buffin No. 54-640 Street . Avenida Obregon City La Quinta Zip 92253 APN # 774-274-007 La Quinta Permit # 0201-046 S Log # Study Area Tract # BLK 267 Lot # 7 Square Footage 1738 Type of Development Single Family Residence No. of Units' 1 Comments 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 facilityfees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,738 or $ 3,562.90 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 CC / Valley Independent Bank - Augustin Paz Teklephone `: • Name on the check �^ r By 'Dr. Doris Wilson Superintendent 'J f Fee couected /ex pted by Annette Barlow Payment Received $3,562.90 Si nature �ti �lJ Check No. 261914 g 40TICE: Pursuant to 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 rbove 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 :ollect 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 DECErr 182VO RC DISTRICT - PLANNING REVIEW FORM': CITY uF uAWry iA PLANNING DEPARTINIf:k" : This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District per Section 9.50.090 of the Zoning Code. Its purpose is to determine: . 1) that the proposed house design does not duplicate the- same architectural style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. / ('6A,S 121ZSrV /-Z//g/o( APPLICANT PAZ CONSTRUCTION SITE ADDRESS 54-640 Avenida da Ohrec APN 774 -_-L74 - 007 CASE NO.: 2nni -sag LEGAL: LOT 7 BLOCK 267 UNIT CHECK AND APPROVED BY: Wally Nesbit DATE: S.C.@V.L.Q. Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN. information -5 Consistent with MDG on file (as A�� applicable MDG filing required (5 filings since 9/3/98) 1 Architectural variety within 200 feet of the surrounding area: Colors Materials Architectural design features .:. _... Planning CommissionOR L T LIN JUS T No. mmunity Dev. Dept. APP V D Cl O (�lU TA No. fxhibit CO M N .. DEE PMEN EP TME T r DATE h ran ditions RTIFICATE OF FIELD VER TION AND DIAGNOSTIC TESTING CF -4R Projekt Addres$ S Builder Name Builde Contact Telephone HERS Rater Telephone Plan Number Sample Group Number Cg^ing Signature `Date Sample House Number Firm:HERS Provider: cTG Street Address: 7i;'6f�UYii�NGf ��lrL�o City/State/Zip: Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT The house was: A Tested . ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form. Distribution system is fully*ducted (i.e., does not use building cavities"as plenums or platform returns in lieu of ducts) Where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination with cloth backed, -rubber adhesive duct tape to seal leaks at duct connections. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM @ 25 Pa) values Test Leakage Flow in CFM If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) Jri,J Check Box for Pass or Fail (Pass=6%o or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent ( Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection ULL— ❑ Yes is a pass Pass . Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan.' 2. ❑ Yes ❑ No -TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow = ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail '` �1�8 I.'rt TALLATION CERTIFICATE � b 4 DUCT LEAKAGE AND DESIGN DIAGNOSTICS CF -6R, DUCT LEAKAGE REDUCTION Pressurization Test Results (CFM @ 25 PA) Test Leakage (CFM) �0 7 Fan Flow ; If Fan Flow is Calculated'as 400`cfmlton x number of tons, or as 21.7 x Heating Capacity in Thousands of Btu/hr, enter calculated value here If fan flow is measured, enter treasured value here Leakage Fraction = Test Leakage/(Measured or Calculated Fan Flow) = TO - 371 -Pass if leakage fraction 5 0.06 ❑ Pass Fail ❑ For AEROSOL TYPE SEALANTS"ONLY - The following diagnostic testing was completed: Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER F MSHING WALL: ❑ Yes ❑ No 13 Pressure pan test or House pressurization test 13 Yes ❑ No ❑ Visual Inspection of Duct Connections4114 ❑ ❑ Pass Fail MTHERMOSTATIC EXPANSION VALVE (TXV) �es ❑ No "Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection M ❑ Yes is a pass Pass Fail ❑ DUCT DESIGN 1 • D Yes ❑ No ACCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. 2.13Yes ❑ No TXV is installed or Fan flow has been verified. If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow = ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fall ❑ I, the undersigned, verify that the above diagnostic test results and the work I performed associated with the test(s) is in conformance with the requirements for compliance credit. [The builder shall provide the HERS provider a copy of the CF -6R signed by the builder employees or sub -contractors certifying that diagnostic testing and ,installation meet the requirements for compliance credit.] z 6,ld?l Tests ignature, Date Installing Subcontractor (Co. Name) OR Performed General Contractor (Co. Name) COPY TO: Building Department HERS Provider (if applicable) Building -Owner at Occupancy Certificate of OccupancyN, City of La Quinta Building and Safety Department �`FoFTM 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 compliance with the various ordinances of the City regulating building construction or=use. For the following.- BUILDING ollowing:BUILDING ADDRESS: 54-640 AVENIDA OBREGON Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0201-046 Occupancy Group: R-3, U-1 Type of Construction: VN Land Use Zone: RC Owner of Building: THOMAS BUFFIN Building Official Address: PO BOX 134 City: LA QUINTA CA 92253 By: DANIEL P. CRAWFORD JR Date: MAY 31,2002 POST IN A CONSPICUOUS PLACE