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SFD (0307-046)LICENSED CONTRACTOR DECLARATION • - --I hereby affirm,,,inder 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 68290'.213 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). .n ( ) l,' as owner of the property, am exclusively contracting with li'c'ensed 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 penaltyIof 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 8,r., xL FUND Policy No. 2269.001Sr'T3740 (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 shall forthwith comply with those provisions.l v ,,,Date: Applicant ! " * Applicant ✓ ✓1 �� •rJ-� 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, inde & hold harmless the City of La Quinta, its officers, agents an loyees) 2. Any permit issued as a result of this application becomes nu work is not commenced within 180 days from date of issuaLbi permit, or cessation of work for 180 days will subject permit to I certify that I have read this application and state that the above i correct. I agree to comply with all City, and State laws relating toconstruction, and hereby authorize representatives of this City to theabove-mentioned property fo6risspectiioon purposes. �Signature (Owner/Agent a ' Date BUILDING- PERMIT PERMIT#- ' pi LOT DAT.E.�y/y / /(/ 1/}� C9V�ALUATION_ $.qry 9'�^ 50 $" 1+ TRACT. BY/ 213 JOB SITE' �r ` : /'r i d ` * ": ADDRESS -4'�I`TIDF"aAwL""i0�9Ci APN OWNER'S - 1 ,-'CONTRACTOR/DESIGNER/EN (NEER ' THOMAS BT -WIN JS.litiiD.L FdDDT9070H P.0,.:1SOX 134 41418 0 R}?m&rAGT- DR. ' � LA QtM1°9:A CA 9225.3 B?RNMA DU= A 922.01 (760408-11528 M4 3724 USE OF PERMIT awaix FANMY Iwmtalo r 1403 S.F. SFD PERMUT DOM NOT rNlCaf= BWCK b11tJA4 POL)i.!S.PA OR DRVVEWAY APPROACH (i TRACT C0143TRUCTION 1,409,00 XF P(AaVpAvo , 56.00 S:.? C•��CEt�e���t��t:X' {•. -�' S2g.00 ��' , rFfW4. %,D Cogr OF CCD1V;s.'S;T2iTC.''7.i.m P'ERMITT'EF, SIWAPM CONSTRUCTION FEE 101-000-4118-000 558111%. PLe9Ai C"FICK FEE1131-00044-328 $483,30 4 FEE WOW 101-00D-433.3.3 4350,00 - DAIrtrMUIC:ALfME ELECTRICAL FEE 101-000-420-000 $108,13 :PI,•1Dman4a me .101-000-414-000 _ $118,00 S'3'I301<` O NOTION AEE •' �.C��MD 161.001-2.81.040 98.71 MAD''= PY40 r -101-000-423,-000 $15.00 DEVELOPFR. IMPACT FBE 9;I,AD5.00 PRECISt 2??,.AN 101-000-441-345 $100,00 . .5iU�3•-�"O'I1�.L CO23iJt;°I,:I0�1'A1.Jli 1?L.,PiJ ��i'1�r`I� ;�"s,�3�33.1 � ;ISS PRF,*PAID 2?M 4350,00 TOTAL FKr%W.fil VP71 ►'9.1:9$ NOW 16 2003 ... .. F LA QUINTA 9: NCE DEPT- > ti RECEIPT DATE BY * — — «— - D FIN% ED INSPECTI INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I 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 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wail Firewall Exterior Lath _ G� Drywall - Int. Lath ` 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 Pibg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines - Q Heater Final Water Piping Plumbing Final - Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection —,-z 5L Q,?.40WEncapsulation Gas Piping Gas Test Q O 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 46 Utility Notice (Perm) 030-OY(;) Building Owner T4tyl 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO Del -7 /1 LA QUINTA, CALIFORNIA 92253 Mailing Address , O.t 16 O X 14 City Zip Tel Contractor %� y� i 6 /(`I Address Zili l a el ITeI...t State Lic — City & Classif. �ACe Cl Ci % Lic. # I Arch., Engr., Designer Address Tel. CityZip State Lic. # LICENSED CONTRACTOR'S DECLARATION 0;1 reby aft m hat I licensed and provisions of Chapter 9 (commencing with Section ofDiv'i03 oft aBuess an rofessions Code, and my license i in fu I force and tTU DA E OWNER -BUILDER DECLARATION 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 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 (5500). I : 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 of 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.) 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.) i7 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 Code.) Policy NO. Company ('l 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, 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 performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name- Lender's ame 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 slate that the above information is correct. 1 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 WHITE = BUILDING DEPARTMENT APPLICATION ONLY BUILDING: TYPE'CONST._OCC. GRP. v� A.P. Number / L� — �. " o G O Legal Description L % -7 Project Description /C 40 size Ft. Siz e r �J New ❑ Add ❑ imated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS No. No. Dw. Stories Units Alter ❑ Repair ❑ Demolition ❑ ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from C Side Set t,from PrgQty Lin FINAL DATE INSPECTOR— Issued Q Issued by: t SUN �P�rf�iW Validated Validation: .—YELLOW = APPLICANT PINK = FINANCE CERTIFICATE OF COMPLIANCE Desert Sands Unified School District z4�co 47950 Dune � Palms Road Q BERMUDA DUNES r 7/1 O/O3 La Quinta, CA 92253 ) RANCHO MIRAGE C7 Date INDIAN WELLS DESERT No. 24697 (760) 771-8515 �Z PALM LA QUINTA :V �INDIO `^ O JJ Owner Thomas Buffin APN # 774-093-008 Address P O Box 134 Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0307-046 Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 17 53400 Avenida Mendoza 1408 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 - Unit 4 Unit 9 Unit 5 Unit 10 Comments 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 1,408 S.F. or $3,013.12 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. 287316 Name on the check Telephone 760/408.7528 Funding Residential By Dr. Doris Wilson Superintendent em Fee collected /exempted by Sharon MCGilvrey Payment Recd $0.00 $3,013.12 Over/Under . Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), thi wi 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 the building or installation *p ermit 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 FES -12-2004 04:56 PM CERTIFICATE OF Plan Number Sample Group Number P. 01 CF -4R i ing Signature ate Sample House Number Firm:HERS Provider: �G,� S�OGJ_' Street Address: citylstate/zip: ZW 014in-Ira Copies to: Builder, HERS Provider HERS RATERCOMP IAN E STATEMENT The house was: KTasted ❑ 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 co ply with the diagnostic•tested compliance requirements as checked on this form. Distribution system is fully*ducted (i.e., does not use building cavitles 'as plenums or platform returns in lieu f 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 zqxv If fan flow is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) m. . e Check Box for Pass or Fall (Pass=e% or less) ❑ THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent es ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is Installed and Access Is provided for Inspection Yes Is a pass ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. 0 Yes 0 No ACOA Manuel D Design requirements have been met (rater has verified that actual Installation matches values In CF -1 R and design on plan. 2. O Yes 0 No f +. 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 13 eS Fail A10 0' Pass t 'is a� •�' �- - Cbrtificale-of`Occqpancy.. oF9r� Building & Safe y Department i This Cert►ficate;s issued pursuant to the requirements of Section 109 of the .California -Building Code, cer>tifyiWg that, at. the time of..issuance, this' structure was `in :compliance with- the A sof the Building Code and the various: ordinances. of - the City. regulating.. building construction and/or use. - BUILDING ADDRESS: 53-400'"ENIDA-MENDOZA T 'Use' classification: SINGLE FAMILY DWELLING"- �'x t ';Building Permit No.: 0307=046 Land Use 'Zone: :Oc6upancy,GroupR-3 _ Type -of Construction:'VN, , " — R 4 Owner of Buildin THOMAS BUFFIN - �. Address: 0.0. BOX 134 ;a g• City.-ST-ZIP: LA QUINTA: CA 92253 - '+ By:, KIRK KIRKLAND.. yd4^'l' t = Date:}02-20-2004' t- Y. Building Official _ � . - •4:. ,.. ` . _ r y '• _` .. s i POST IN A CONSPICUOUS PLACE"