SFD (0012-022)52370 Avenida Madero
0012-022
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 71e -Signature of Contractor
OWNER -BUILDER DECLARATION
f hereby affirm under penalty of perjury that I m exempt from the Contraci r `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).
() 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 -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.
( ) 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 Policy No.
STATE FUND
(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 agreethat if I should become
subject to the workers' compensation provisions of Secti6n 3700 of the Labor
Code, I shall forthwith comply with those provisions/
Date: ° r,471 Applicant /_ a> r" sZ.T Z_az.s?=a! t..
Warning: Failure to secure Workers' CompensationAQefag"e*VawfQp
shall subject an employer to criminal penalties and civil fines. 6p'to-$1 P;000, In
addition to the cost of compensation,,6mages 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 'Elie 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 tof'
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 statelhat the above information is
correct>.I agree to comply with all City, and Stag laws relating to the building
construction, and hereby authorizer epresent trves of this City to enter upon
ur 1
the above-mentioned propejty for gspection •uses.
Signature (Owner/Agent) /jr f ••}r /Date
p to Z-iEc.F`1;
r:
BUILDING PERMIT PERMIT#
DATE b VALUATION LOT .. TRACT ! rY '
JOB SITE
ADDRESS
OWNER
CONTRACTOR /DESIGNER / EN (NEER
THOIAM X3UMM
x tmm,. M'b'm#: s. INC. ,
"T0,s Jk: C)R maw't3 )AS, t:f3'IS 2,
S 51-370 }2 ►Z 2"I,DABElR7 iCT• A% W1 "S 2, RM.
LA QVINTA fes, 92253
7,,A QTTU TD. CA 02253
(760)S(A- 866 CTILH 835
USE
OyyF PERMIT q} p 7• µ qy ry y9
13.fi7V 11 CT„itS7:la" INVELLeld' G
.
PEIN IT CESR3, M.0Ll;DE BLOCK WALL, 01001&SPA OR.
yRIVEVASYiPROkX14, WhMA R'%AAA,q i
'iRAC f CONSTRUCTION 1,409,99 SF
31 T. W0010 YKNCF, 200M 1,y'
tr1, 4 MUD SF
r
F'onmilm con, 01"" consmucylos'?
CMI S71I.t1C 20W FEU 101.400rt919-WO
!ai„f.4N f;° EC'.K 0199 $495,21
MECMRICALFRE 101.000.421.000 $53,50
FAIAtC1'1i£ A91 !`QEF 101.000.420-000 $199.70
i l RSO 101-1000-419-000 %11017101
ra” rT 12.ONO MOTION FPS a RILED 1,01-000-241-000
0RAD N0 FFly 1113>Wi-M,.000 PDA
,DP,V RLb P1?Jt 9.1N1;r ACT .FEV, $1,907.00
PUC;IVEPLAN i 103.000-441"345 $100,00
TIRE l!'3FF01 1 E 4250.00
a.
; 3- G*b1"a :Giik 1YX1 ANI) kJW Cl:'1WK
;3, J•1ai,SLS
IMAM I'TLl;:. ?1 ID kms'
4250.00
10TA . PU?l ? .' MISS DITE NOW
Vi,9 64&-D
MID
RECEI , D /
BY, f i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings y'(,
Underground Ducts
Ducts
Slab Grade
?/
Return Air
Steel
Combustion Air
Roof Deck
Z , O /
_
$, % -
Exhaust Fans
O.K. to Wrap
cc of G
,
F.A.U.
Framing
Compressor
Insulation
4Vents
_ o
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/ /
!!!
a.Y
Final
Final
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
Gas Test
Electric Final
Waste Lines_,p_
'
Heater Final
Water Piping
s
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
6 , o
Encapsulation
Gas Piping
Gas Test
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)0.1
/- /o . v i jet- 1;, ,L r
Building .%
Address
Owner
Mailing
Address w
P.O. BOX 1504 APPLICATION O
78-495 CALLE TAMPICO
✓ r ,- SLA QUINTA, CALIFORNIA 92253 _
-ft C, k tt r71 I `-r?'2 t 1 -:2,4 • 1. $66o
IIJG,
Aaaress I
City f
Zip
Minimum Setback
Tel.
State Lid.
& Classif.
No. Dw.
Units
City
Lic. # "
Arch., Engr.,
Designer fir` j ^)LcvJ %
All/ ice. -
Address) _
Tel. r 1
city p
h—i
Zip
INSPECTOR
State
Lic.#!
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) 6f Division 3 of the Bu i'ness,an df rofessigns Code, and my license is in full force and
effect .iN i"'" '+7i tLQ, % /" . 1 . 'CJ•-,
I hereby affirmthat I am exempt from the Contractor's License Law for the following
reason: (See. 703./.5, Business and Professions Code: Any tty or county which requires a
permit to construc(, alter, improve, demolish, or repair agstructure, prior to its Issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions7of, the Contractor's License Law, Chaprer 9 (commencing with Section 7000) of
Division 3 01 the" Business and Professions Coder that. he is exempt therefrom, and the basis
for the alleiteb exemption. Any violation ot/Secfion 7031.5 by any applicant for a permit
subjects th applicant to a civil penalty of n ot ore than five hundred dollars (5500).
C 1, as owner of the property, or my,dmployees 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.)
1 1 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 contractors) licensed pursuant to the Contractor's License Law.)
1"7 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. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATIONINSURANCE
(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 lhp 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 if work thereunder is suspended for 180 days.
I certify that 1 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
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number -7- 2 f 4 2• - C!,) / 56
Legal Description Lo
Project Description VUI '
ZONE:
/1/kz 41 57s' -
Minimum Setback
Distances:
Sq. Ft.j U No.
Size Stories
No. Dw.
Units
New P,-" Add ❑ Alter ❑
Repair ❑ Demolition O
All/ ice. -
its fvn
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Z 0 ---- r
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading LJEC
Driveway Enc.UUU
Infrastructure kit-
TOTAL
REMARKS
i
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
f -
r a Desert Sands Unified Schooi District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 7601-771-8515-
CERTIFICATE.
60-771-8515 CERTIFICATE. OF COMPLIANCE u '
r,
Date 1/4/01 APN # 773-242-01L
No. 21446 Jurisdiction La Quinta
Owner NameThomas Buffin Permit # 0012-022
No. 52-370 Street Avenida Madero Log #
City La Quinta Zip 92253 Study Area
Tract # BLK242U1 Lot # 11 Square Footage 1409
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 afthis 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
1.05 X 1,409. or $ 2,888.45 the property listed above and that'bdilaiing N y
permits and/or Certificates of Occupancy for this square footage in this proposed project may nw be issued
Fees paid By CC - Valley Independent Bank - Mr. Lench Telh ne..760-5,64-1866
Name on the check, ;h
!{ }
By Dr. Doris Wilson ;„
`?
Superintendent 0 1 MINk` *
Fee colle4/exeed byAnnette Barlow Payment Received $2,888.45
.Check No. 235138
Signature
OTICE: 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
Bove 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
Alect them on the Distdct('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
IIk C FiQTEY' ,Lid 6y
Crift t U'. 'T' 'iIE'coi%at,ANNY
Ti' DMAS BUFFIN
WHEN RECORDED MAIL TO:
THOMAS BUFFIN
R.O. BOX 134
LA QUINTA, CA 92253
CPN 17 3 - _'ov
--f- \ r -
M
$
U
PAGE
SIZE
DA
PCOR
NOCOR
SMF.
MISC.
A I
R I
L
COPY I
LONG
REFUND
NCHG
EXAM
-Tra ; 0 GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt -of which is,hereby acknowledged, LA QUINTA REDEVELOPMENT AGENCY, A
PUBLIC BODY, CORPORATE AND POLITIC j
hereby GRANT(S) to THOMAS BUFFIN, AN UNMARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY SC
all right, title and interest in and to the real property and all right, title, and interest in, and to the improvements pertaining to the realty
which are attached or affixed in any manner to the following described real property (Exhibit "A") attached hereto and by this reference
made a part hereof, which either generally or for purposes•of this deed are part of the parcel of real property in the City of La Quinta,
County of Riverside, State of California, as described`as follows:
SEE EXHIBIT "A" ATTACHED HERETO AND BY THIS REFERENCE MADE A PART HEREOF
- LA QUINTA REDEVELOPMENT AGENCY, a public body
corporate and politic
Date: /o. / I — ev BYV
1011RK Lt)e i s-5
ITS: '
State of California)
County of )
On- /9 UO JJ b fore me,
personally appeared ,I% /^/ice U e /,,5f2
ersonally known to me or ❑ ce
to be the person(/ whose name(j3') is/, -)p6- subscribed to the within instrument
and acknowledged to me that he/eke/Wy executed the same in.his/,Vr/tWr authorized
capacity(iX,), and that by his/l O/th,il signatureV on the instrument the personjd), or
the entity upon behalf of which the person i) acted, executed the instrument.
WITNESS m i an official seal. (SEAL)
9 ,
Signaturc:7"-P-W, A
Commission Expires
REGEPJIA HENSLEY
Commission # 1274458
Notary Public - Coof x,
Riverside County .
jy rn . 5q hx ALg 19, MD4
CAPACITY CLAIMED BY SIGNER
173 INDIVIDUALS
0 CORPORATE OFFICERS
O PARTNERS t
O ATTORNEY-IN-FACT
O TRUSTEE(S). '
C3 SUBSCRIBING WITNESS
O GUARDIAN/CONSERVATOR
O OTHER
SIGNER IS REPRESENTING:
(Name Of Person(s) Or Entities)
_773-24., 'o T- R. A_ 020-0!> POR. N//2 SEC- /2 -T- 6S R 6E . MIS w
020-0>/ ASSE
Is. FOR
_ SSCAfr PuRVOSEs ORLr:
O
.. — 020-091.
AVEN.!9A JUAREZ
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- A
of BLK_ B L-0 K. .. pNtEZU
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8L C e 4/0 w o92 Vii. PJ p p p
MADERO
! AVEN/DA
'l O `
6L —BLK<
.Q I BL OCK ., S !I e6•
Ir
J 1 1 $ \4• - i
Poe .o
J0,h
i
h
Na
n0 '4C S -A/
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• s _ • - " - 'Notice: 7ttieisneilheraplatnorasu
'•:J :: TRA6 G\Od a:..ORAD ?`' .. _ ; furnished merely asac:+lrar:ienc+t
/r% in locating the land'in&pred her '
e _c f reterencetoStreets and otherland. N
N I O A L± 1 is assumed try reason of any reliance
AJ E oa
e,51ORfd..
y
- -
lo e ,
Son Ce me/if¢ Al Vale i o Ouu /o Un 7 No: Y MB /B%4
I ,.. yam.•- _ _ F _ ' . w ` -
24.
wES `f? cP 2
Unit iYo_ /7 MB. %9i
iVc
- COW
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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 the 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.
APPLICANT LENDEL VENTURES
SITE ADDRESS 52-370 Avenida Madero
APN 773 242 011 BIN NO.: CASENO.: 2000-360
LEGAL: LOT 11 BLOCK 24-2, UNIT- 1 S.C.@V.L.Q. ' .
F
CHECKED BY: Stan Sawa DATE: 2 ZO lfc;
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
Corimpatibility Review
.
Case logged and number assigned
Verify legal and APN information.
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since -9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
\ ,
V
Other Requirements:
r . czyK,12At 6 ,
Certificate of.,occuplancy
City of La Quinta
N
Building and safety Department
OF
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, Ithis structure was in compliance with the various ordinances
of the City regulating bu1/ding construction or use. For the following:
BUILDING ADDRESS: 52-370 AVENIDA MADERO
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0012-022
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: THOMAS BUFFIN Address: 51-370 AVENIDA BERMUDAS, STE. 2
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
/ . Date: JANUARY 10, 2002
Building Official
POST IN A CONSPICUOUS PLACE
4