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SFD (0201-127)54305 Avenida Martinez 0201-127 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions Chapter 9.,(commencing with Section 7000) of Division 3 of the Business a d Professionals Code, and my License is in full force and effect. Licensee# Lia Class— Exp. Date 78 83-41 D TUC, IM Date .!f Z 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. ( ) 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 ggPolicy 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' compensationprovisions of Section -3700 of the Labor Code, I shall fort with comply with thos pFouisions*`" .- •-- ,Date: //I V v Applicant 4 - Warning Fail re to secure WoAk6r§'"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 authorizerepresentatives of this City to enter upon the above-mentioned property fortinsp ctio purposes~' ,iSignature (Owner/Agent) r - '" Date Z.U% BUILDING PERMIT PERMI0n2 DATE ? VALUATION }y , • .. pry LOT TRACT / "40 0 JOB SITE ADDRESS5{-31MiWpA. d s .(Lti 7 APN 774-253-014,, OWNER CONTRACTOR / DESIGNER / EN (NEER TOM BUMIT/.Mli .B'1rrtA UCLWWN ARAUCIOJAN14WC PO 73OX 517 110.:SOX, y 1 i t..A+ UINT4. ;--k 9 253 L.11.QWaFMA CA 927,563 USE OF PERMIT 911401y, DAMIL t .S`ITV- PERMi1' DOES 140T 9i1 JCK;WA1.,1,S, PL7OL? OR iafWi ,WdL`,E" TRACT C-014STRUCTIO..N SF ; PORCH/PATIO 5&.00 Sir GAAACNICARPORS 46100 Nit 5 F11. WOOD FiNI CE 204.00 F CONSTRUCTION ME 101-00-418:-000 PLAN CHECK FRE :109.000-4 M19 )ZL,.ZC RIC AL. FF42 101 _000.4210.•000, V.51.1.30 PL,UMSI: O iti:ir 101-000-419-000 S 1`RON10 MOTION ME • RE 10 101440-241 -000 $9.31 CxF2.Ai YW1 i i;119 10)-000.43.0 10 $20.00 DEVELOuPF-1IMPACT YLE $la3f)e.Uh f 91iWCISKPL&W 101-000-441,-,W $100.00 M 'DEPOSIT ,ani -000-439-318 4250:00 *23,464x )ML 1W TFIX.MDUT NOW }ar ~BY .RECEIPT DATE / - DATE FINALED & INSPECTOR ./3.0x.. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap 3 pZ F.A.U. Framing T/ Compressor Insulation . B2-- Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath .2 Z Final Final 6 - POOLS - SPAS BLOCKWAL 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 — - QZ Heater Final ' Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 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,Z Building Address,-) 1a/2-7 'Pj. ., 4 4 " xkp, e- - J , >aa- P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO L n QUINTA, CALIFORNIA 92253 '7 n/ / 7-7 A yn "" (J ( i OwnernA 1 -kUw O Mailing ` BUILDING: TYPE CONST. J OCC. GRP. -Zs-3 Address J'I A.P. Number ?-?I/ 0 ! y p7F j i C7 Legal Description `2 la C - CityZip J ' -q Ief Z S Tel. Z r r Project Description 6- — Contractor Address "' t (7© CityZi fel.State Lic. ty& Classif. c. # Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add D Alter ❑ Repair O Demolition ❑ Address Tel. City Zip State Lic. If 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 Estimated Valuation reason: (Sec. 7031.5.8usiness and Professions Code: Any city or county which requires a permit to construct, after, 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 PERMIT AMOUNT 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 Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. !: 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 Const. 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, that such improvements are not intended for Mech. r 't '4k) provided or offered sale. If, however, the building or improvement is sold within one year or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) Electrical Plumbing t 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 , S.M.I. t 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 Grading l}f—_ r _ j; i7 I am exempt under Sec. B. 8 P.C. for this reason Driveway Eno.j ' ' j Infrastructurew,1 t 2001 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. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS' WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation Of 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address This is a building permit when properly tilled out, signed and validated, and is subject to FINAL DATE INSPECTOR _ expiration if work thereunder is suspended for 180 days. I certify that 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 Issued by: Date Permit construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Validated by: - Signature of aOplicant Date _ Mailing Address Validation: City, State, Zip APPLICANT PINK = BUILDING DIVISION WHITE = FINANCE YELLOW = Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 1/18/02 APN # 774-253-014 No. 22843 Jurisdiction La Quinta owner NameTom Buffin/Mike Brauckmann No. 54-305 Street Avenida Martinez City La Quinta zip 92253 Permit # 0201-127 Log # Study Area Tract # BLK 300 Lot # 3 Square Footage 1501 Type of Development Single Family Residence No. of Units 1 Comments Construction 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 1,501 or $ 3,077.05 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 CCNalley Independent Bank - Mike Brauckmann Telephone 760-250-5151 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Signature Nicola Wong Payment Received $3,077.05 Check No. 261933 NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, STAF51996) this will serve to notify you that the 90 -day approval period in which you may protest the4ees 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 DistrictCs)(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.,, RECORDING REQUESTED BY; . AND WHEN RRQORDED,b9AIL TkM DEED AND, UNLESS OTHERWIQE SHOWN 6ELOW, MA!L ?AX ®TATEMENTS TO: Gilliam Thomala Buffin power Ssokers E).0. Soy; 134 La Quinta, CA 92233 SPACE A®OVE T.IIS LMFOR RECORDER'S USE APA 774-253-01 4 The undersigned grantor(3) daelare3(s): Grant Deed _ Documentary transfer tax Is S sly. 3 ;ty; computed on rdq valve Of properly conveyed, or { ) =mpvted on furl ve!U8 1089 value of liens ®n(l eneumSraP.ces remai ling tat time of Bala, ! ) UHncorpora'ed arae: ( ) .City of _ FOR A VALU AKE-CQN61DERATION, receipt of which is hereby slca<iiowledged, CHARLES & DOLORES GUERRA hereby ORANT(S) to VILL.IAM THOMAS ]9UFFIIV, an unmarried man tae.real properly in the Clty of Le' quanta CCitrlty of Riverside Stats of Callromia, described is Lo: 3 of 1310tk300 t'nit Ido, I Santa Carnalita at 7a1e LA i , J 4r.ta, as Per rtap recexdt!,d is $sok _ Payee f maps CO "d9 ! of Itiv®r ida County, California j ;• De December .12, 2001 !eC Signet -ire of Grainlor 61st® of CaHfatnla'' ) County oC .•_ ) SS. _ y CHARLES & DOLORES I GUERRA 1 _ ;psrso'nohY`aPpearsd -, .•_ , S & npLORE , GUERRA carsc^.aily k^cwn !c me {c^ proved to ms on tha'CeaIB or eetstacto L ;v:dancO to be the psrsvn(e)`wtoas nsm0(5) is/are sabscrbao to the wl:i :n instrument rind aookrcMedged-to me that hb/sho/they ex4eut0;1 the . ag -.rs in hlelhe llheir' euttaoriced oaaanity{les), andthat by y a n. rtne;r 6ions wrs(s) o'n ''ys Inrvumon iho Fe;so,l,s;, or the entl!y i up•nn deretf of w!tieh.11lo.pero.ort(s)sCled: eiteeitad the instruntier,t: w'MNMR= my hand area offal 6001: S' nelur. _ I NA!LTAX STATEMENTS TO, i. l 9i a' hJ S' ',3;ICH ,AMOd Q u 1 N" Uc \ RECEIVED o JAN- 2 2002 RC DISTRICT - PLANNING REVIEW FORM t 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. APPLICANT BRAUCKMANN INC. SITE ADDRESS 54-305 Avenida Martinez Verify legal and APN information APN 774 - 253 - 014 CASE NO.: 2001-603 LEGAL: LOT 3 BLOCK CHECK AND APPROVED BY: 300 UNIT 2: _ S.C.@V.L.Q. Wally Nesbit 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 since 9/3/98) Architectural variety within 200 feet.of the surrounding area: Colors Materials Architectural design features c r✓oit s ry . _ ov.--rove Requirements: Other Re ` 2' q oN „ Lrn it /'DP -wt O ;C] Initials Ca Exhibit eso g Commission lanni City Council om a No. Z Y 2 Z:70 3 `_,r CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING l' Project Title CF -4R 1 Date �,. l�� Nizr U��hn �Grh. � �� • ` ,. Builder Name Build'er Contnt,,-,,,A -1714Z 9 Tele hone Plan Number HERS ter ele hone Sample Group Number C ing SSi nature ^ Dafe Sample House Number Firm: v �-'�SSl� HERS Provider: Street Address: 7� 4-0 &77,IjyV� City/State/Zip:- ���n ll, 1-144 Copies to: Builder, HERS Provider HERS RATER COMPLIANCE STATEMENT 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. 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) _, 4x- G Check Box for Pass or Fail (Pass=6% 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 ❑ 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 Certificate of Occupancy City of La Quinta Building and Safety Department :This Certificate issued pursuant.:to the requirements of Section .1,09 of the Uniform Building Code, -certifying that, at the time of issuance; this structure ,.was-in:compfiance with the various ordinances of the. City regulating building construction or use. For the following: BUILDING ADDRESS: 54-305 AVENIDA MARTINEZ Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: Owner of Building: TOM BUFFIN/MIKE BRAUCKMANN Building Official Bldg. Permit No.: 0201-127 VN Land Use Zone: RC Address: P.O. BOX 517 City: LA QUINTA, CA 92253 By: RICHARD KIRKLAND Date: 06-13-02 POST IN A CONSPICUOUS PLACE T's ? { + at 3r all. 1 •1 A 0 M ..: A N m' T's ? { + 3r all. 1 •1 T's ? { + 3r all. 1