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SFD (0307-020)I 7 j LICENSED CONTRACTOR DECLARATION I hsreby affirm under penalty of perjury that I am licensed under provisions of�j Chaj3ter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. • .1. 'License # Lic. Class Exp. Date r Date % T_6 Signature of"Contractor ii 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 penaltyof ,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: Cartier S'1' '1'E iiYl�iZ� . • Policy No. 2 _ toIowl P-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 Co I shall forthwith comply with those prov sions. f rDate: i! -�> Applicant Warning: Failure to secure Workers' Compensation coverage is -unlawful and shall subject an employer.to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on • his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & Shall, indemni & hold harmless the City of La Quinta, its officers, agents and employee 2. Any permit issued as a result of this application becomes null and void i work is not commenced within 180 days from date of issuance 'of Sul permit, or cessation of work for 180 days will subject permit to cancellatio . I certify that I have read this application and state that the above information correct. I agree to comply with all City, and State laws relating to the buildi construction and hereby authorize representatives of this City to enter up the abo4e-mentioned property for inspection purposes. ; Signature (Owner/Agent) �`" / .�� Ze-, ' Dates i �'� •? BUILDING PERMIT PERMIT# DATE — —� _ VALUATION LOT - TRACT JOB SITEru - ADDRESS" r�t3���:1 Si�i���ei APN , _ _i=�9! , tr OWNER CONTRACTOR / DESIGNER / ENGINEER .040MAS fiIMM T3AWD 1. ADDIN611-CCU y PD, BOA; ) 3+M1D.R LA2UWA <' CA 92,253 BY-O'.IVti',1•I AIAr: NES CA 42201 r� P�fl oE4-'PY2i3 �. c w7t.4 )4 _ USE OF PERMIT 9-KCLE F,tMMY :T�tId2:1:LT3�e, � r 401 5.1e.5N,0:P$?iw l'3° DOM, 140T X3f(,"7:13L;El, 81,0Cr �1IAJ, yIt'i�g1AP Ofa I}RMEiFiAYAPPIiOAC I i t t TRACT (.9ONSi'RUC'TIO'ti 1,4444.00 SP POPCIVI)A IQ- S7, 00 SYi' 0AY3A.Ci1slCARPORT 487.00 NF .fj''�:�#j•S"1I.�1!'d'. COSY OF COINSMi7'MON � 89,24440 ' p�q;{�yg,Q. 1 Y eJ] iY'..� wr "Ll SY•'6YY66Y,61'�RY 1 C0NISTRUC` ION FPY '101.000*41.8=000 $304i". ; PI,.AN CHECK '[1 E9 %493: TO - r"EM, DEPOSIT PdiLC i .td[C�iJ� EE .1.01-000-421 _000 RLECTRICAL ME 101 -SIG 0.420.000 SIs88.78 ' !?1.Y3IL�I3It�iCi P'Fi�, 10'1-000.419-000 S'i'1a.CyNG MOT10H FRE - I4.EOID 101-000.241.1000. GI',AI)R7fI'FR :911 -006.423-000 $0.00, DEVELOPER1I12:FACT FEE PRECI$F PLA14 101-000-"! -345 �2ilt}.04 :41313•-T't7TAT, CO}*TQC`}��TC;`i101sT1•'.AFY7:P'L.FC1`T.C3.`ECK �3>13i�0.C�1 425,6,00 JUL 16 2003 CITY OF LA QUINTA FINANCE DEPT ' RECEIPT ' DAT / /1 C', By --� DATE FINAL INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings TI Ducts Slab Grade Return Air Steel Y Combustion Air Roof Deck Q Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation — 6 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final — �Q Final - BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 37 Encapsulation Gas Piping Gas Test C 27 Appliances Final 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) COMMENTS: TA P.O. BOX 1504 APPLICATION ONLY Building 78-495 CALLE TAMPICO Address�L3-37oA6,641060-;-'a LA QUINTA, CALIFORNIA 92253 Owner —� I Mailing Address p' 13q f City Zip _ Tel. Lig t v;N� i 3 JG1-azno Contractor n _ State Lic. G City" & Classif. G8a !Q Lic. q Arch., Engr., Designer Address Tel. CityI Zip I State Lic. q '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 reason: (Sec. 7031.5,Business 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 rile 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 ($500). 1-,' I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) - II I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor($) licensed pursuant to the Contractor's License Law.) I'l I 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 Corte.) Policy No. Company fl Copy is filed with the city. 0 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 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 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 1 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 it 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- ,"entioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE'CONST./-�1 OCC. GRP. A.P. Number_ Legal Description Project Description Sq. Ft.J L q No. No. Dw. Size I 1 y Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mecti. ' Electrical - Plumbing S.M.I. Grading Driveway Enc. Infrastructure 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 Date 7/10/03 No. 24698 Owner Thomas Buffin Address P O Box 134 City La Quinta Zip 92253 Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 Q' BERMUDA DUNES r rn RANCHO MIRAGE CJ INDIAN WELLS ^r PALM DESERT .y (� LA QUINTA t 41YDIO Y� O APN # 774-093-007 Jurisdiction La Quinta Permit # 0307-020 Study Area No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 18 53370 Avenida Mendoza 1444 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Received CC #28317 in the amount of $3,081.16 and $9.00 cash n 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. 287317 Name on the check Telephone 760/408.7528 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sha n cGilvrey Payment Recd $0.00 $3,090.16 Over/Under r Signature C 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 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 per Section 9.50.090. of the Zoning Code. Its purpose is to determine: 1) that the proposed housing 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 transmit this information to the Building and'Safety Department as part of your correction list. Please attach additional, explanations as necessary. APPLICANT: SITE ADDRE: APN t rT -. ors - oa -I' CASE NO.: K55 LEGAL: LOT- /8 - BLOCK 013 UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: DATE: 7//,y/c 3 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; Architectural design featuresHaso ---- -- -- Other Requirements: AwrovedO it ity Council .........,. - snit j _ w omm.un-i wev. • pr.r als ......... �.,..._.. Ca a No. o ......�.....,... �... u wan conoiaons .,.._._... .... 0 � ZCertificate 6F06cupanqy.., lsea r 'OF Buildin } & Safet .DeV artment This�Certificate is'issued pursuant to the requir'enients of Section 109 of the 'California Building ,Code,-. certifying. that, at the time of issuance, this -.structure was in compliance.. with the provisions, of the Building -Code' and ` the, various ordinances' of the -City, regulating. building'. construction and/or,use. z A 4 - BUILDING ADDRESS: -53-370 AVENIDA MENDOZA Use classification;.SFD ' Building Permit 46.: 0307-020 -Occupancy Group: R-3. "T ype of Construction: VN : 'Land Use -Zone: RC Owner of Building: T. BUFFIN _ ? r Address: P.O. BOX 134" City, ST, ZIP.: LA QUINTA CA 92253: By: KIRK KIRKL;AND ' Date: 2-9-2004 <, Building Official , E 11 POST IN A CONSPICUOUS PLACE �I (I.