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SFD (0102-234)54165 Avenida Martinez 0102-234 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencingwith Section 7000) of Division 3 of the Business and Profe:3signa!3 ,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: ( ) 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() I, as/wner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code)/ 'Ni `m exe pt unde Section B&P.C. f ? gtl os" n Dat :?•= — ., Signature of Owner WORKER'S COMPENSATIO DECL-AfE ftON 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. (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 shat forthwh comply with those pr ouisiofi ./f , Warning: Failure to secure°Workers' Cosat n coverage is unlawful and shall subject an employer to criminlenalties end civil fines up to $100,000, in addition to the cost of compensation damaga`s as pvided for in Section 3706 of the Labor Code, interest and attorney's 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 a? 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 i spectiion.-purposes. r 11< Signature (Owner/Agent`; - ' '" %' r "" Date22 ''), ^ BUILDING PERMIT,, PERMIT# ` DATE] l VALUATION LOT 0J0)0.-,)_34 TRACT ? JOB SITE f ' ! I APN ADDRESS T o54- .695 ANIXw iA MA ."c ,,` . '7'74-221-x:19 OWNER CONTRACTOR /DESIGNER / EN INEER PO:1:1O X 13.4 LA C,?1.1ftgTA CA 922.53 CBS40 USE OF PERMIT SFJ -(Pg HAI !b'lAt3',°QP.)-PE 11' .tM INOT JINCLUDE: r T,G+E :t :I, !?'CitaUORJ f + ►: APPROACH.. TRACT CONSTRUCTION 1,501,00 OF 4O119!C/ro 3ry a' P(,/A T! Ip 58.00 V piyyOp5 t (C 0.0w,80 S 7r-. WOOD FENCE 200.00 7.f+' EMMATUD WST 010 C-014S'.,£'aRUMON 9. a4J B. Ef CaNS'1RUC'rl N YES. IUl=.66o'4 I Cum MUM PLAW CHECK ft'1!E 101-000 439-318 $5.13.415 Mt'XH `N1CAt- F)K1' 101.000.421.000 $50.00 XL6CR1CA,L FEC $1:1130 PE_UMBIA 40 F '101-000-419-000 s1 wR STROM MOTION PER 4- R&SID 101-000-241-000 $9.31. MADIM FRE 101,0 W-473-000 17.0.00 I)EVELOPEYL MPAC1 ME $1,907.00 PrT1n.EC111119PLAN 101-(K30,441-30 9100100 _ •, FEE i:#f;POSIT 101-000-43D-318 4350.00 9` ISOMMAALL CE RUC;'1°1O1sJ'A 1.1 PLAN CHKIC Ul 42,50,00 TMAI a:° FEE,',;D: NOW $3 .4 c 1 MAR O 1 Ae dd RECEIPT DATE DATE FINALED INSPECTOR r INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Sef7Backs Fc .ns & Footings _ j — — S 7 Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck3 - 30 - o ( _ cS 7 Exhaust Fans O.K. to Wrap / 7 . o ! 57- F.A.U. Framing . y3 _ d, g7 Compressor Insulation .4 v y _,pe S 7 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath o C 57 Drywall - Int. Lath , ' Z /oILL S j Final Final I 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 LinesJ_— Water Piping / 3 I S7 Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 3 S —p ( S7 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPRC ALS 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 / (7 v r Utility Notice (Perm) :r='a'llFwil►.i r+1.-3Cs "! - ; ,.#tw! Building 54.1 Address T4tyl 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO 1At2 1ll1;i $.LA QUINTA, CALIFORNIA 92253 Owner - ✓ //r i✓ Mailing ,s Address 419 Ity - Zip Tel Contractor / Address ?e9 .01 14IW41 ZIpqJ s, Tel 4l1y4n7 %Q State Lic. r— City & Classif. Lic. # ( Z -z- T- Com% iJ . Arch., EngL j Designer/,'04/4 4101JI4i%.0 A a/ j //j ✓16*O'h 1 Address Tel. .Address /lrff r f vl ✓ la Zlpgdd3`3 State Lic. # LICENSED CONTRACTOR'S DECLARATION r 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's 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 live hundred dollars (E500). l2 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, Suisness 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. 1! however, the building or improvement is sold within one year of completion, the owner-buildekwilI have the burden of proving that he did not build or improve for the purpose o/ sale.) 11 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.) A I am exempt under Sec. B. 8 P.C. for this reason .i DateG--Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate off consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company r7 Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE 1 (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) ` I certify that in the performance of thg work forwR1 ch t if permit is issued, I shall not employ any person in any manner so as to become S'S[tje to the Workers' Compensation Laws of_Callf rn a. 0 7 / Date CJ Z Owner , NOTICE TO APPLICANT: It, after making this Celfific a o/ Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions orIthis permit shall bedeem revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performapce Of he work for which this perm't is issued. (Sec. 3097, Civil Code.) i'' 4- / ' XYZ Lender's Name—t- 15' Ith ON O N •'c 73('•Ij Lender's Address -• - f: - A .4 Ake This is a building perml hen properly'fifledaQu , signed and validated, and is subject to expiration it work thereunder is suspend for 180 days. I certify that I have read this applic ton and state that the above information is correct. I agree to comply with all city ,ft6ounty ordinances and state laws relating to building construction, and hereby a)IthI t e representatives sof this city to enter the above- mentioned property for inspect'on'purposes. Signature of a0plicar Date Mailing Address City, State, Zip Z p s- a APPLICATIO;:,IY BUILDING: TYPE'CONST.4r, . OCC. GRP. Ir A.P. Number 7 Legal Description L 1},' 6L.Iw/ 291 f,ua t1 2 Project Description ....w GGA a ci C3 A 1 ,cam; ctZ Sq. Ft. No. No. Dw. Size f$'✓%'" Stories Units Ne., Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 4 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: tl Date Permit Validated bv: 9r, -"A Validation:A * Y Qt7 k. WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION V Notice: Document Cannot Be Duplicated Date 2/28/01 No. 21719 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE owner NameWilliam Thomas Buffin Jurisdiction APN # 774-221-019 La Quinta Permit # 0102-234 No. 54-165 Street Avenida Martinez Log # city La Quinta zip 92253 Study Area Tract # BLK297 Type of Development Comments Lot # 7 Square Footage 1501 Single Family Residence 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 m the amount of 2.05 X 1,501 or $ 3,077.05 the property listed above and'that b. wilding, t permits and/or Certificates of Occupancy for this square footage in this proposed project may -no w bt' issued Fees Paid By CCNalley Independent Bank - William Buffin T'Plephonc 760 564-8470 Name on the check By Dr. Doris Wilson , .. Superintendent Fee collected /exem ted by Annette Barlow Signature Payment Received $3,077.05 Check No. 235306 NOTICE: 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 to the District(s) or to another public entity authorized to collect them on the Districtes)(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 01/09/01 10:25 FAX 17608049062 COI)DIONWEALTH TITLE Z002 RECORDING REQUESTED BY: I AND WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: William Thomais. Buffin Power Brokers 8.0. Boy; 134 La Quinta., CA 92253 SPACE ABOVE THIS LINE FOR RECORDER'S USE The undersigned grantor(s) declare(s): Grath Deed A.P.N. Documentary transfer tax is $ ( xy) 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, Murice C. Danielson hereby GRANT(S) to WILLIAM THOMAS BUFFIN, an unmarried man the real property in the City of La Quinta Coilnt ' of Stale of California,. described as y Riverside 774=2212119 _ , and Lot 7 of Block 297 Unit No.Santa Carmelita at Vale La - Quanta, as per map recorded in Book 019 Pages _082 mf Maps, Records of Riverside County, California I Dated January 19,-2001 state of California ) County of ) SS. On before me, ,personally appeared 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 he/she/they executed the same in his/her/their authorited capacity(ies), and that by his/hedtheir 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 seat. Signature MAIL TAX STATEMENTS TO, . sa Roan 109-9 ir--wx Signature o g f Grantor Murice C. Danielson ZA't (Avenida WHO WER DRIVE r-- ElSf Set, o) IDA: MART/ EO14 fo?A CI C 091 iix, 14, 9.kA x I k Y X"2' I'1 NOOnO OO O J97 O vet IDA: MART/ EO14 fo?A CI C 091 Yi 9.kA 1r k Y I'1 NOOnO OO O J97 O ab IDA: MART/ EO14 fo?A CI C 091 Yi 9.kA I'1 NOOnO OO O O IDA: MART/ EO14 fo?A CI C 091 9.kA I'1 NOOnO OO O O IDA: MART/ EO14 fo?A CI C 091 9.kA 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 THOMAS BUFFIN SITE ADDRESS 5.4-165 Avenida Martinez APN 774' _221 _ 01.9 ' BIN NO.: G CASE NO.: LEGAL: LOT 7 BLOCK 297 UNIT 27 CHECKED BY: Stan Sawa DATE: 2001-404 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 Compatibility 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 ti Other Requirements: -@-r .Gom xa b j 1 1n 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: 54-165 AVENIDA MARTINEZ Use Classification: SFD Bldg. Permit No.: 0102-234 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: WILLIAM THOMAS BUFFIN Building Official Address: P.O. BOX 134 City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 06-08-01 POST IN A CONSPICUOUS PLACE