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SFD (0105-216)53425 Avenida Martinez 0105-216 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 . f76Y04 . 3143,C: XL .^' ,.. :: 0'71'31 Al f i' i! ! I ' Date 'Signature of Contractor _.OWNER-B I't ER`DECL i4RATJON 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, Vrofessionals Code). a (.4)d 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. 'wpp 1 (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'Oprovisions,.of,Section 3700 of the Labor Code, I s4ll forthwith comply with those provisions. Date: Applicant Z1larmng Failure to secure Worker9'`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 authorizerep"re es ntatives of this City to enter upon" the above-mentioned property for° nspec, on --purposes. r j Signature (Owner/Agent) +"=_- Date 4 114fv77 . : PERMIT PERMIT# /BUILDING DATE // , VALUATION LOT 0.Q -216 TRACT / w (r JOB SITE . ADDRESS APN gg01-45 9"iUCNY4KffTft:Z COY n t1 i % ••ll. 3.••Y '', A. OWNER CONTRACTOR / DESIGNER / EN INEER r .TCP:T OX 517 F0 -B X 517 ,i.A, `LT71iTm CA nvril LA Q:Uj .'.rA CA 92253 t';760)449d5422 MIA 2397 USE OF PERMIT .53rt - F>91WIT S OES War INC:LUDE BI=K'fl4°.+ XA4 POOL t; f:13YL2`dWAY , . r1 PR.O.ACH, (01T MA -27, SR Y9-'.1 PLAX) TRACT CJ7NRUC ION 8 1bF iJSroNA710 E' iaRlG rINUO T (FAO +9,VK80 g in" WOOD WN)CY LIF 3104116I.L0'3J771. S:eAA (70 91, 4.a.L LRnffb*1+1 i.r.i.1n &1 ;J.si• K, Oa"M4J PTFyy Et, y ^] meq` PMOTF Y.F.G.7Xi, f) ATn" . CONSTRUCTION FES 701 -000-418-:O)i3 $60810 PLAH C;'i1M .fxElf, 101-000-439-318 $508.53 MECHANICAL ANIC., L M 101.000.421.000 $3 9.$91 d-UXTIUC A1. ME 101-000,420-000, $130,99 PLr;M?rNIG ioi. 1 49 000. $110.8 ;4,T1ZCs 8C8 01-000-M MA, 1 Fft 101-000-423,,000 $20.0.9 PRESCIU, n 1 1-000. 1 5 FAIR, ORP Jug", C°CO3da`t;1 l 5`dC i f1 iNtT .7 A T a ' Cf.WpA°tr„C1 $3r Sr .nU6 py i9 IftT $ 'b7 ,I IXI-PAYy. .T," /.3rmaf LTi L1,00"k -$2 0.00 611 F-JNxlictDEEP+T 7ay ,1 9 r p ,:im1.9 J. 3J'Tv.a O'i'M' pyo , .gi r•1'b! w RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade — / _ S T Underground Ducts Ducts Return Air Steel Combustion Air Roof Deck '- /a2.0 C 57 Exhaust Fans O.K. to Wrap ?_ ©L g'7 F.A.U. Framing -7.-5(-OL S" Compressor Insulation $ - r -O( 5? Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. LathCq Ol _ Final Q/3 0 5 BLOCKWALL APPROVALS Final POOLS -SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam AppPoval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping _/ o / c-7 ` Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection = O( 57 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) P.O. BOX 1504 APPLIG'1 ,TION ONLY Building , 78-495 CALLE TAMPICO I r--=- - 1 A tf lam, S Address 'l UINTA, CALIFORNIA 92253 Owner .r - Mailing ng cy` w / f j i BUILDING: TYPEE''CONST. _OCC. GRP. Address d L. LSI `-T - / -7 t r f Q I/ A.P. Number City Zip Tel. ' C.-- C Z 2 i 3 )bo 2.J t1 j'/. Legal Description Lu Cj ✓ G k < C.. L r t%Gc L Con ttf actor1°, t, / ,1 i Project Description Address City Vol Zip 7 Tel. State Lic. City & Classif. Lic. # Sq. Ft. SD No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. + S City IZip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Divis`/iqn 3'of the Business and Professions Code, and my license is in full force and effect. / 1 SIGNATURE t --r:.. —r DATE . / OWNER -BUILDER DECLARATION Ihey 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 applict 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). (: 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.) I 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 contractor(s) licensed pursuant to the Contractor's License Law.) I"! I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 17 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, atter 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 I hereby 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 -of this city to enter the above- mentioned property for inspection purposes. Signature of a0plicanl Date Mailing Address City, State, Zip C ted Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT 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 Issued by:— Validated by: Validation: 7 2001 CITY OF FINANCECE DEPT DEPT WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVIS '- ---- Notice: Document Cannot Be Duplicated Date 6/18/01 No. 22135 Owner NameBrauckmann, Inc. No. 53-425 City La Quinta Tract # B221 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Street Avenida Martinez Lot # 9 Type of Development Single Family Residence Comments APN# 774-091-021 Jurisdiction La Quinta Permit # 0105-216 Log # zip 92253 Study Area Square Footage 1492 No. of Units 1 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 facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,492 or $ 3,058.60 the property listed above and that building I 1 1 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 - Mike Brauckmann Telephone` '760?,409-5422 Name on the check By Dr. Doris Wilson Superintendent .► ` t x Fee collected /exempted by Annette Barlow Payment Received $3,058.60 Signature ,"-, Check No. 247505 IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 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 -.. -1. - -.- r, - - - I . . . ......... . . -.- .... ... .... ---- 01/09/01 10:25 FAX 17608049062 COMMONWEALTH TITLE RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO; William Thomais Buffin Power Brokers B.O. Box 134 La Quinta, CA 92253 3T %1 . SPACE A90VE THIS LINA FOR RECORDER'S USE The undersigned grantor(s) declare(s): Grant Deed A.P,N, 774-091-021 Documentary transfer tax is S ( %Y) computed on full value of property conveyed, or ( '=) computed on full value less value of liens and encumbrances remaining at time of sale. ( ) Unincorporated area; ( ) City of FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Thornblad, Lloyd H. hereby GRANT(S) to WILLUM THOMAS BUFFIN, an unmarried man the real property in the City of La Quinta Slate of California, described as , Coilnty of Riverside Lot 9 of Block 211 Unit lio, Santa Carmelite at \ Quinta, as per map recorded in Book Pages tiff Maps, Records County, California , and 'ale La of Riverside Dated May 1, 2001 Signature of Grantor State o/ California ) County of —)Ss. -... _,. On before me, Thornblad, Lloyd H. ,personally appeared •.... Thornblad, Lloyd H. personally known to me (or proved to me on the basis of satisfactory. evidence) to be the person(s) whose nerne(s) islare subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/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, _ fps RC DISTRICT -PLANNING REVIEW FORP is to be used by CDD staff for review of single family dwellings in the RC (Cove fl) 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. 9FCVOFORpRo 'cess/ APPLICANT Brauckmann, Inc. qss/GNFR f_ N \` / SITE ADDRESS 53-425 Avenida Martinez APN 774 - 091 021 LEGAL: LOT 9 CASE NO.: 2001-476 BLOCK 221 UNIT CHECK D BY: Michele Rambo 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 and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Verify legal and APN information Consistent with MDG on file (as applicable MDG filing required (5 filings sinceK/' _ 9/3/98) -°' - -t°° Architectural variety within 200 feet o the surrounding area: Colors Materials Architectural design features AP ey Joey EX -1 oMMU CAS£NO DATEjDP E a o Other Requirements: dq 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: Ose Classification: SFD Occupancy Group: R 3 53-425 AVENIDA MARTINEZ Bldg. Permit No.: 0105-216 Type of Construction: VN Land Use Zone: RC Owner of Building: BRAUCKMANN INC/BUFFIN Building Official Address: P.O. BOX 517 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 10-03-01 POST IN A CONSPICUOUS PLACE