SFD (0212-038)53380 Avenida Martinez
0212-038
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
1x6
1dax
"" 4 ` C,'IContractor,---(
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:
( ) 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.
1,(d ) 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 rATl±1'UIJ ; Policy No. 2"_ 001 1-2003
(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 shall forthwith comply with those provisions.
Rate: , _, Applicants=r t/re!t j
/r •
ell r f,
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. I t
1. Each person upon whose behalf this application is made & each person at
whose request and forwhose benefit work is performed under or Rursuant 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 D
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#ifor/nspectio/n'/prposes.
Signature (OVuner/Agent)/ ! A = Dater f -3!- i
A
BUILDING PERMIT PERMIT#
DATE VALUATION LOT f TRACT
1. 1.3 - Mem
JOB SITE
ADDRESS nWJW
APN
774-092,007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Vr'd ,ItAMRTM-IN
rvtYi p):i,,.ummyTox
U.. Q'31Y. RrA CA. 91253
BERM. WISA—L)'f?1;WS ct" 9,22o I
(760)408-7528 tXL4 372,4
USE OF PERMIT
3.431 SQ.11T. 1?SIOMIC9 1: f doors raotipdWe block wak
fanceN prAl or qfa. A gaparge ci&uwap approach plard is
lwqL4>Y' d &oia the .17altltn Wf.As t)g1mtmgs*
TRAM,' C'ONSTRUCTIOR 2,431.00 SP
.PORCT•IIPA TO 97.00 V
C3C,t4Rilf'?1:ffr`•ARPO7'7 t 48100 SF
I .91NMAIM COST OF C'OMIRVI'CHON
88,5388 .
PMUr Fn SUAMARY
OO11STRUCTI014 RF 101.1000.41 f 000 $390,09
PLAA CHECK M- All . '. 101-0 0-439~318 S489.75
r
I EEK DEPOSIT 101-000-439-318 4250100
Mw"Asu1CAi. "m ; 101-000-421-0X) 0
l L,E°cTluC'•I►,i..Il?;1S ' 101.000.420.000 $109,33
101.>WABP1dC4 YEE 101 -00" 19-000 $122.75
S'FRC N01 MOT1010 FES • RUM 101-000441 -000_1.1'* UIR$
CIRiA.i<.3RK3 Mir, ! 101.4'?f1"23-Q001 $14.00
12I"VE''.C?F'm lml,.A R€. ( $:#.,405.00
MCISE PLAN 'U 101-000-4A1 345
i
to{J'MMC.lis I.VO)TAM RT
18
1XV9 1'Ifi&PAIDx,710
-3,150,00
-
TC3!iAL FF!i.i a R' YXV_S 1Aii1: RMY
JAN 13 LoOJ
OFlAQr-.
CITY DEPT.
pIP1A ICE
RECEIPT
DATE
BY
DAT ED
INSPE CITOO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ K
Underground Ducts
Forms 8 Footings
3 f . !J3
Ducts
Slab Grade
7-nf
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
-
F.A.U.
Framing
�—
Compressor
Insulation
A7 3 7
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 - v3 I
BLOCKWALL APPROVALS
POOLS - SPAS
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
�� Z% ��f�-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)ELL=-E
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) �- ��
COMMENTS:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 1/9/03 La Quinta, CA 92253
No. 24011 (760) 771-8515
Owner
Buffin
Address
53-380 Avenida Martinez
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
Lot #
Unit 1 18
Unit 2
Unit 3
Unit 4
Unit 5
Comments
No. Street
53-380 Avenida Martinez
igor
0
Q BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS d
PALM DESERT ,y
V LA QUINTA ,
%INDIO
O. Y
APN # 774-092-007 -
Jurisdiction La Quinta
Permit #
Study Area D
No. of Units 1
S.F. Lot # No. Street
143.1 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
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 (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,431 S.F. or $3,062.34 have been paid for 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 CCNIB - David Addington Check No. 278019
Name on the check Telephone 760-408-7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,062.34 So.00
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
ivov•;j• cuut 1u;1VAM
No-5bfl F. 4/IU
THE ESCROW SOURCE, INC.
44-421 TOWN CENTER WAY, SUITE C, PALM DESERT, CA 92260-0000
(760) 776-4640 * Fax (760) 776-4650
Escrow No.: 023666-SASQ
Escrow Officer: SARA QUINI'ERO
Date: October 25, 2002
ESCROW SLTh04ARY:
Broker has on deposit for account of buyer $ 1,000.00
Buyer will deposit prior to close of escrow $ 44,000.00
TOTAL CONSIDERATION: $ 45,000.00
Escrow holder is instructed to close on or before November 28, 2002, 0
TITLE/VESTING
Buyer to hand you any additional funds and instruments necessary for you to comply with
instructions herein, Obtain an Owners/ALTA Standard Coverage Form policy of Title Insurance
from ORANGE COAST TITLE with their standard exceptions and provisions. This policy is
to have liability for an amount not to exceed 545,000.00. The policy is to be issued on real
property in the County of RIVERSIDE, State of California, as follows:
PARCEL NUMBER 774-092-007-8
LOT 18, BLOCK 212, UNIT 20 OF THE SANTA CARMELITA VALE LA QUINTA, AS PER MAP -
RECORDED IN BOOK 19, PAGE 38 OF MAPS, RECORDS OF SAID COUNTY
Property Address: APN: 774-092-007-8, LA QUINTA, CA 92253
The title policy is to show the title to the property to be vested in:
THOMAS BUFFIN, A Married Man As His Sole and Separate Property
ENCU MBRAN CESIEXCEPTIONS
The policy is to be free of encumbrances except as follows:
(1) General and Special Taxes and Special District Levies not due or delinquent; this will include
the lien of supplemental taxes, if any, assessed pursuant to Chapter 498, 1983 Statutes of the
State of California.
(2) Covenants, conditions, reservations (including exceptions of oil, gas, minerals, hydrocarbons,
and/or lease without right of surface entry), restrictions, rights of way, and easements for
public utilities, districts, water companies, alleys, and streets.
(3) Assessments and bonds of record,•if any, not delinquent,
INSTRUCTIONS
CLOSE OF ESCROW:
The "Close of Escrow" shall occur 45 days after acceptance. Buyer and Seller shall deliver signed
escrow instructions to Escrow Holder within 15 days after acceptance.
DEPOSIT OF FUNDS INTO ESCROW:
Each of the undersigned hereby acknowledges and understands that pursuant to State of
California Assembly Bill 512 ("Good Funds Legislation") which became effective January 1,
1990, funds deposited into escrow and/or deposited with the Title Company for use in this
escrow by the Property Owner, Buyer or New Lender in any form other than a wire transfer may
cause a delay in the close of escrow and/or disbursement of funds at the time of closing. Each of
the undersigned hereby indemnifies and holds THE ESCROW SOURCE, INC. and its
Officers and/or Employees harmless with respect to any delay in closing and/or
disbursement of funds due to compliance with the Provisions of "AB 512".
***SEE ADDITIONAL INSTRUCTIONS ATTACHED HERETO AND MADE A PART HEREOF***
Initials
Each of the above signed states he has read the foregoing instructions and understands and agrees to them.
DESIGN
GROUP
CON S ENT ANl USE AGREEMENT
This is in reference to the plan Known as "SonFelipe"., in which ownership of said' plan is
shown to be Coronel Construction (see attached tloor:plan hereto). It is agreed that the entity .
known as Thomas Buffin..and/or Power Brokers, hereinafter referred as "Buffiri", may use4he
plan at the following locations:
1) 52-900 Avenida: Mendoza
2) 51-925 Avenida Obregon '
3) 53-380 Avenida Martinez
It is agreed that Lench Design Group. may modify these plans as. required by
City of:La Quinta, without cost to Leach Design Group. All compensation.and use:fees that
may be required by C.oronel Coristrunction shall look only to "BufFn° for collection.
President
0 Page 1
A;P: Leach; II
Resident
Certificate -of Occupancy
City of La Quinta.
Building 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 compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 53-380 AVENIDA MARTINEZ
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
Owner of Building: WILLIAM BUFFIN
Building Official
Bldg. Permit No.: 0212-038
VN Land Use Zone: RC
Address: P.O. BOX 134
City: LA QUINTA, CA 92253
By:, KIRK KIRKLAND
Date: MAY 30, 2003
POST IN A CONSPICUOUS PLACE
MAR 04 903 16:25 FR
nF .In, foimalion
.ToBuild 4n
Engineering . Consahing • Testing
TO 9-7777155 P.02i02
REPORT or FIELD COMPACTION TESTS
TESTED FOR: POWER BROKERS PROJECT: 53-380 AVENIDA MARTINEZ
PO BOX 134 LA QUINTA, CA
LA QUINTA, CA 92253 '
DATE January 13, 2003 ---- -- OUR REPORT No., 073-30012-2
TEST DATA: (1) Very fine to very Silty sand. OPT. MOIST 10.5%
u
TIESNO.
Np.
2
TEST
DEPTN
+I
gII
El EVaTIpN
FG
FG
SAIL ID
NUMBER
1
MAXIMUM
LAB DRY *
DENSITY
—.—_
117.0
-- --
WATER
CONTENT _Spec
.10.70.6
WET
NSITY
DRY
DENSITY
—'---
108-93.1
LPMCENT
ACTIpN
COMMENTS'
. 90% Min
1 - A
1
117.0
11.24.1
F312
.
122.0
122.3
111.695.4
110.0
110.5
94.0
94.4
1.......
1 - A
1 - A
3
- g+l
FG
-FG- ---
1
1
117-0
117.0
10.9
10.7
—
I-- L.vlr,yllure: xouse pad.
1
NW
corner of
pad
2
WE
corner of
pad
3
SE
corner of
pad
4
SW
Corner of
pad
-- ----
...... ..... _..... ._. .._ -..... - -- --
L—
NOTES: TESTS PERFORMED PER ASTM D2922-96 &ASTM 03017.96 "COMMENTS: 1. FILL MATERIAL A, TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES SHOWN: Lbs. per cubic foot 2, BA KFILL B. PERCENT COMPACTION DOES NOT COMPLY
WATER CONTENT: Percent of dry weight 3. BASE COURSE WITH SPE OMPAIQNS
PERCENT COMPACTION: 9ased on maximum dry 3. SUDBASE CO C, REfT ST OP PRIATIO g TEST
density obtained on sample indicateo by S. SOIL CEMENT D, MOI.TURE 1N EXCESS OP SPECIFICATIONS
VI
soil I number. 6. OTHER E. MOI TURF- BELOW SPECIFICATIONS
(l) ASTM D1557-00 METHOD A
TEST INSTRUMENT: STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement, ADJUSTMENT DATA M: D:
TECHNICIAN: Juan Nunez Respectfully submitted,
Professional Service Industries, Inc.
TkeSE TEST RESULTS APPLY ONLY TO THE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR 2LCVATI:1NS.
REPORT$ MAY NOT BE REPRODUCED, EXCEPT IN FULL. WITHOUT WRrrTFN PERMISSION BY PROFESSIONAL SERVICE INDUSTRIES. INC.
PSS A-+68-7 (<)F
Professional Service Industries, Inc. - 42.240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 780/?R1-5790 - Fax 780/341.5794
'
xy< x
MAR -4-2003 TUE 12:41 TEL: NAMETOTAL PAGE.02:
P. 2
MAY -21-2003 07:05 AM
CERTIFICATE OF PI:ELD VERIFICATION ANA DIA
Pimp
HERS Rater
PCifying Signature v
9
P.01
CF -4R
4J41,p
Builder Name
Plan Number
Sample Group Number
Sample House Number
HERS Provider:G_
Street Address: 7 L4 DY Cltyistate/zip; ZN
Copies to: Builder, HERS Provider
HERS RATER 90MPIJ NCE ST -rMENT
The house was; 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,
11 Distribution system is fully'ducted (i.e., does not use building cavities as plenums or platform returns in lieu
,4,,°f ducts)
18J 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)
Duct Pressurization Test Results (CFM @ 25 Pa) Measured
values
Test Leakage Flow in CFM 79
If tan 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 Leakdge/Fan Flow) = ID
Check BOX for Pass or Fall (Pass=B% or less)
Nass
THERMOSTATIC EXPANSION VALVE
Fail
XV or Commission approved equivalent
4yes 1) No Thermostatic Expansion Valve (or Commission approved J
equivalent) is installed and Access is provided for inspection
Yes is a pass Pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
Pail
Q 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 Q Yes ONO TXV Is installed or Fan flow has been verified, If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow W
D
Yes for both 1 and 2 is a Pass Pass
❑
Fail