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SFD (0307-019)v� LICENSED CONTRACTOR DECLARATION I:hereby affirm under penalty of perjury that I am licensed under provisions of H , :•Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 'Wt Professionals Code, and my License is in full force and effect. Cn License #,. Lic. Class Exp. Date I`CYLO Ir- LLJ \ - r` 682901 3 d 7 11 rl_f Z t Date Signature of Contractor> " �/ �'� �✓j_ 0. F- (D OWNER -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ License Law for the following reason: Z ( ) 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 LO a Date Signature of Owner O� Q WORKER'SICOMPENSATION DECLARATION o 1 hereby affirm under.pena y'fof perjury one of the following. declarations: ,r cr O () 1 have and will maintain a'certificate of consent to self -insure for workers' X W !�= compensati'o`n; as provided for by Section'3700 of the Labor Code,: for. the Om J., Q performance of the work for which this permit is issued. QU ( ) 1,have'and will maintain workers' compensation insurance, as required by do Q Section 3700 of the Labor Code, for the performance of the work for which this 11 rn .� permit is issued. My workers' compensation insurance carrier & policy no. are: 'IT ZCarrier �p �•+ Policy No: - ob Z)S7.AlE, FUND D- 00t9'�II`?-2003: J '(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 subjectto,th'e workers' compensation laws of California, and agree that if I should become 3 subject to the workers' compensation provisions of Section 3700 of the' Labor Code, .1 shall forthwith comply with those provisions. Date: r'` Applicant e,r, j ✓�� Warning: Failure to secure Workers' Compensation coverage is unlawful and i' shall subject an employer to criminal penalties and civil fines up to $100,000, in x 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 tY for a permit subject to the conditions and restrictions set Aorth 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. i 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 inspection purposes. Signature (Owner/Agent)''. %-tea' r� t M Date/ ( a BUILDING PERMIT PERMIT# DATE"_ ,/J VALUAT.ION„moi . LOT' �`� TRACT JOB SITE APN ADDRESS Wnrgn � A.�.R'�.'�1DC�i'�kA. ;, �., STT�r•''"�EZP . . OWNER CONTRACTOR /,DESIGNER/EN INEER '.I`['i0Idm Ial'f%`1+`A4 ,a 17KVID L,' JD7313�'t�'3'� P.O. BOX INS , � k� ,. , t .N . . 41 l8t+JW� A (�,MrlA "CA' 92253.. LA k;.b L �1 isdN S f"'t' �s^, (7603)4Ci —7528 MIR 3724 r, USE OF'PERMIT '4444 .?.5Fl_'1XKM T DOES NOT, INCf.UI31P'BLOCK WAU, NOOLJSP'.A,.OK 1DI3.4W?nATAYMI)ROAs".II' kCT CONSTRUCTIO14..' 1,444.0 Sir ! PlfiCfiEdPA7'lfa.14.9.i111C ' "LiARAGE(C'ARI''Oft': ' ''�i ll!►�Xt. '1) COST ().'F d.'_0XT6" � C.-1l�0N ',pp/�ps ���E'�►.fi� ' ` T v�.7�q-� FEE XSp�' .aCavJ46T BY.ita� 53 V,5'✓Y�v7.E!lRY ' • • 5 CC`MMUCTION 'RE 101-000.418-000 ' $394,n , 'PLAN C,iiI:tX czRE $�1.•ij:.'0-�i:i�-5125 $4S_�•d8 FEE DEPO3IT 101, 00o 113 42S21A IVECl' ANIC .IFEE. x01-.00-.-421.00fi 531. a E1dI�.�iRIC:ALFEE 1W1'»�0tS�4�OJ�0003 RGIJMBINO"'fesR 101-000-419 000.. �4io-UA STROM 410TION FU = R9.81D 101w000-241-000 �Ia,99 ORA MHO ME AQ1..Qp0��S23�(I0(I �1�.Cflt f3E'd 3 P Ii i PlAt-T F9£+; 2,4US flq PRECISE VLM4 101_000e44:1`*345 �I011:ti0' -i -xOT ►I cC,l+ I�CITION AND PLAN' CMCK - G=J - IMS I'ztE-R xU)FM 4250,00 LUL 16 '2003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE Ya. BY`, `' DA FIN ED INSP O 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 F.A.U. Framing Compressor Insulation !:5;1Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final OL Final BLOCKWALL APPROVALS steel POOLS - SPAS 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 Unes 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 ,Z - . O3 Sr Appliances - Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole — Q 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) / o COMMENTS: k 49 0L 1504 P.O. BOX TAM APPLICATION ONLY Building ^^�� %/' 78-495 CALLE TAMPICO Address Ste) l7®:/�AI�/� - LA QUINTA, CALIFORNIA 92253 /N Mailing Address P o� U 4lty /O V�u �O�J/A IZI aOiL�3 ITel. G�—e?'4'7o Contractor Address Mt�ma State Lic.I City 1- & Classif. ,R- 0 G /9 a Lic. # Arch., Engr., Designer AddressTel. City IZip IState Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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 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 thealleged 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"] 1, 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. 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 1, 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.) fl 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 f] Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of the workfor 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 pertormance 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 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 construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip BUILDING: TYPE'CONST-%/-3 OCC. GRP. A.P. Number%7 /+ QQ/; C Legal Description Project Description _S ,�c ro �gl Sq. Ft. I // No. ) No. Dw. Size 7yy Stories / Ilnifc New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ mated PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure -WrY70F L4 QUIN 1A L EINAN 2,E DEPT - 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: Date Permit Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK =FINANCE CERTIFICAT-EOFCOMPLIANCES Desert Sa ds Unified School District 47950 Dune Palms Road Q BERMUDA DUNES r Date La Quanta CA 92253 Cn RANCHO MIRAGE d 7/10/03 f � INDIAN WELLS ti No. 24699 760 771-8515 PALM DESSRT �y �QINDIo L� Owner Thomas Buffin APN # 774-093-006 Address P O Box 134 Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0307-019 Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 19 53360 Avenida Mendoza 1444 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Received CC #28318 in the amount of $3,081.60 and $8.56 cash 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 1,444 S.F. or $3;090.16 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 CC/Valley Independent Bank - David Addington Check No. 287318 Name on the check Telephone 760/408.7528 Funding Residential By Dr. Doris Wilson Superintendent Fee collect Signature Payment Recd $3,090.1.6 $o.00 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this Will seWto 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 .� Certificate pf .Occu .angy p y. I9B2 G OF�w Buildin & Safet Deartment This Certificate is issued - pursuant to the -requirements hof Section 109 of the. California Building. -Code,' certifying ; that,' at 'the . dh7e Iof issuance, this structiure- was,,in compliance with the." -provisions of the Building -Code and the various ordinances of the; City ~regulating .building • construction and/or use. r f BUILDING ADDRESS: X53-360 AVENIDA MENDOZA Use classification: SFD Buildihg. Permit No.: 0307-019 , _ '. r ' .. r- .; - .t • - Occupancy Group: R-3 Type of'Construction: VN Land Use'Zone: RC' Owner of Building: T. BUFFIN rT , : 'Address:,P.O. BOX 134.' City, ST, ZIP: LA QUINTA' CA 92253 i _ • . , `By: KIRK KIRKL;AND` } Date: 2-9-2004 .. -Building Official -- POST IN A CONSPICUOUS PLACE JAN -12-2004 07:14 AM P.03 F,RTIFICATE OF wrl k H CF -4R Uel@ r /J✓1 /�rJ�� tet.. bi 6 rr �U C1 Builder Name Plan Number , sample Group Number hying Signature to Sample House Number Firm: 'j-6. HERS Provider: _ -C.'# ASOGI��S Street Address: Se"i ClCity/Statelzip: L'q Q(4/a';9 Copies to: Builder, HERS Provider HERS RATER gg PLIANC"TATEIdENT The house was: Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diggnostic testing and field verification, I certify that the houses identified on this form complywith the diagnostic tested compliance requirements as checked on this form. Distribution system is fully'ducted (i.e., does not Use buildln'g 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 leeks at duct connections. r eMINIMUM* *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 E? ?l If fan flow is calculated as 400efm/ton, x number of tons enter 1 calculated value here If fan flow Is measured enter measured value here 1 q Leakage Percentage (100 x rest Leakage/Fan Flow) Check Box for Pass or Fall (Pass=6% or less) ❑ lsass Fail THERMOSTATIC EXPANSION VALVE (TXV) or Commission a22roved equivalent i (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. C Yes ❑ No ACCA Manual 0 Design requirements have been met (rater has verified that actual Installation matches values in CF -1 R and design on plan. 2. O Yes ❑ No TXV is installed or Fen flow has been verified. If no TXV, / verified fan flow matches design from CF -1R, Measured Fan Flow = d ❑ Yes for both 1 and 2 is a Pass Pass Fail JAN -12-2004 07:14 AM CERTIFICATE OF FIELD V D DIAG P.04 'NG CF -4R ;✓p✓ 7I hen tz� 5S r Name Plan Number sample Group-Rurriber�% Sample House•Number Firm: T ,�SOG��I ES MtKb Yrovider: ,TG i�S oG S Street Acaress:7��L0 ,�r�d �oY� ' CltylStatelZip; Lu OyleA' Copes to: Builder, HERS Provider r HERS RATER COMPLIANCE ST MEN Tne 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 ori this form comply with the diagnostic tested compliance requirements as checked on this form. Distribution system is fully'ducted (i.e., does not use bulldln® cavities es plenums or platform retut'ns in lieu of ducts) CSS 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. i—MINIMUM'REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT` puct Diagnostic Leakage Testing Results (Maximum b% Duct Leakage) Measured Duct pressurization Test Results (CFM Q 25 Pa) values Test Leakage Flow In CFM' /? If fan flow is calculated as 400cfm/ton x number of tons enter calculated value here `� i If fan flow Is measured enter measured value here r i Leakage Percentage (100 x Test Leakage/Fan Flow) Check Box for Pass or Fail (Pass -6% or less) ❑ ess Fail QJTHERMOSTA'TIC EXPANSION VALVE (TXV) or Commission approvcd equivalent Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is Installed and Access Is provided for Inspection �1 Q Yes Is a pass pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DE -SIGN COMPLIANCE CREDIT t . 0 Yes T3 No ACOA Manual 0 Design requirements have been met (rater has verified that actual Installation matches values in r , CF -1 R and design on pian, ' 2. 0 Yes CO 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 Fad