SFD (0010-057)LICENSED CONTRACTOR DECLARATION
.I hereby affirm under 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
f�+�
Pate%� Signature of Contractor Ai
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
y,.
( ) 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 th'e property, am exclusively contracting with licensed
contractors to construct,the project (Sec. 7044, Business & Professionals
Code). . •
O 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.
( ,y 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' compensatio�npr-visions of Section 3700 of the Labor
Codef'llshall forthwith comply with r8se rovisions.
Dale: Applicant !1
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 prson 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 authorize, ersentatives of this City to enter upon
the above-mentioned property for,i°spection purposes.
Signature (Owner/Agent) Date -- •+
> wll
BUILDING PERMIT PERMIT#
,
DATE VALUATION LOT TRACT
ct
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/ DESIGNER / EN INEER
W1111A .4M'<%MMSUFM
COMFaubPOPUAIRYHOM40
PO 1r OX 1.14
51370 AVI�'.�'�II1A 131MMUDMO
U. QUJN fA CA. 92233
LA Qi1Ri -A, IC k 92253
(760)564.1967 rw ul 6255
USE OF PERMIT
1eL J`ELy
MWOLCFAMILY
Srey) - Does Nil's' INCI.0 DE; I�f..,�2 X NrAL1LS/P0OU.APl�>ft'.OikCH
?14.9'9ryg�plpM1Z'
DDR %�' . {y
TRACT CONSTRUCTION !.01,00 OF
i)d313.Oh&MAX.10 360 Sig
O.ARA TUC M (110) 9,096.oa
5 FT. WOOD FENCE 2001,130 LIV
HIMMMD COST OF CONUIRUCHON
PFIRMUFixUJI&i��lt RY
MAN CH rrK .WTs' 101 _00(1-4.39-318 $500,12
M MICAL FEE 101.0( 0-42'1.000 $60,60
MRCrRICA1,YTVE 1014100-42€;-000 $1N.44
1'i.1„►p UNO YER 101-000.419.000, 5110.75
S`E'RONO MtS>'"; C N K,1Z - MID 101-000-241-000 WPW
DINT LOI x)Pz!'U IMPACT fEE $1,907.00
PRI.(INS PLAN 101.000.443 TM $100.00
FRIT, DEPOSIT � 101 000-d3S�-31� a�a�o.00
p�y,a,L;r p'+.J�•p,1... i,�L.�A*7 iS .. aaJ�i.; c A� . 'Y S, d'i ' c;.1 C-�,iL
$3,4301
:f. 1sI -PAID FEM
-$230.00
Y02M. U FEES MY, NOW
OCT 0 9 2000
l
Y C)iF LAQkAW .
RECEIPT
DATE 3 ;
BY��r j
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
3� -p�
c'?
Ducts
Slab Grade
'Return Air
Steel
Combustion Air
Roof Deck
L 3 - e-
Sr
Exhaust Fans
O.K. to Wrap
���0 - p
��
F.A.U.
Framing
/•'_p
�-r
Compressor
Insulation
-oZG1�_O
��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
\ `_
Drywall - Int. Lath
Final
s�
Final
.S/3�o(
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 Lines
_ _ _
0 1
Heater Final
Water Piping
/� �-
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Q - 6+0
S7
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
/ Z -<S - 00
S 7
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)�''—
'7
P.O. BOX 1504
Building78-495 CALLE TAMPICO
AddresS� T C � I� r11�`? �% LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 3
CityZip t Tel.
I k1 L-J)i), rl ip {� 5( I �L)7 0
Contractor f (
C��?.it�;'i'l'���� i�l�+`�L-C vI�}1��1it �(lt��t•�
Address
Gity - Zip, r f Tel.
State Ljc. 13130 City
& Classif.-� �. Lic. If
Arch., Engr,, rr ,
Designer �l' )��� L .1�t1 "ti! tt�J ) ({
Address U Tel. 1 r
City1'�
State
`VJ i,�ty .) �' Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I a(p;ficeqq;ed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of t/he sihess.and Professions Coded lie is in full force and
effect. k , anmy license { ®� J q - I,) . (N
SIGNATURE / li-'� '^I' t 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 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 (8500).
I] I, as oner 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
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.)
I'I 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
doesnot apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
17 1 am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that 1 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
Fl 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 the work for, which this permit is issued, I shall not
employ any person in any manner so as to decomIe subject to the Workers' Compensation
Laws of California. — r/A 6
Date 1- I I Owner '. 7�t
NOTICE TO APPLICANT: If, after making this Certllicate 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
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.)
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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of aQplicant Date
Mailing Address
City, State, Zip
APPLICATION ONL
JILDING: TYPE'CONST.GIp �C40, OCC. 1GRP.
P. Number
Legal Description ' UT )I JCC
Description
Sq. Ft. lw - j
Size Al t
Newx Add ❑
S-/ 4
Esti
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
n
No. ) No. Dw
Stories Units
Alter ❑ Repair ❑ Demolition ❑
�y I AMOUNT
f. Z- SCa e", ci
�r
„r
8 J
4A
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 = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
R 47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 10/6/00 APN # 773-235-006
No. 21053 Jurisdiction La Quinta
Owner NameWillatn Thomas Buffin Permit # 0010-057
No. 52-120 Street Avenida Navarro Log #
• City La Quinta zip 92253 Study Area
Tract # Lot # Square Footage 1421.
Type of Development Single Family Residence No. of Units 1
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 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 - 1,421 or $ 2,913.05 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 CC / Valley Independent Bank / Robert. Kellogg TeieF4one 760=564-1962'
• �:, �.
Name on the check
- y f.1
By Dr. Doris Wilson✓^;,,
Superintendent _ '►#'''
z
y
Fee collected /exempted by Annette Barlow Payment Received $2,913.05
Check No. 227433
Signature
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 orother .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 y are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(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 '
4
tw"I -2000 ,1142am From-COWNWEALTH LAND TITLE
'RECORDING REQUESTED BY:
ICAGO TITLE COMPANY , COMPANY
10355KC 207057495
WIL
WILLIAM THOMAS BUFFIN
P.O. BOC 134
LA QUANTA, CALIFORNIA 92253
• 1 a
62 -120
.......... ... _
+7603413216 T-610 P.001/001 F-616,
•R
I . ,
0
GRANT DEED AP
The undersigned grantor(s) declare(s):
DOCumentary transfer tax is $15.40
(XXX) Computed on full value of property conveyed, or .
( ) Computed on full value less liens and encumbrances remaining at time of
( ) UhTECOrporated area, ( ) City of
angale.
FOR A VALUABLE CONSiDPRATZON, recelgt of which is hereby acknowledged,
PRE13ERTCX H. KOCx and MARTA p. XQCN, TRQSTRNS OF THE FREDERICK H", KOCH AND MMIA e, KOCH
FAMILY TRUSr under Revocable Trust Agreement defied 11/22199
hereby GRANTS) to
WILLIAM THOMAS SUFPIN, AN MMRRIED MAIM
the real property in the City of LA QUINTA, County. of Riverside, State of California,
described 49:
Lot 17, Block 92, Unit No.,11 „ Tract Santa carmelita at Vale La Quinta, as per map
recorded in Book 18, Page(s) 75 inclusive o
Of said County. f mapg, in the ofPiCe of tris County Recorder
gated,,September 13. 2000
State of California
County Of
On
before me,
personally appeared
Personally Known to me (Or proved to me on
the basin of sata,sfactazy evidence) to -be
the person (s) whasc name s) is/are subscribed
to the Within instrument and acknowledged to
me chat he/she/they exeaksed the same in
bis/her/their authorized eapacicy(%as), and
that by his/her/their signature(s) on the
Instrument the peraon(s), or the ancicy upon
nehalf of which the persons) acted, executed
the instrument.
WITNESS my hand and official saal.
Signature. '
MAIL TAX STATEMENTS TO:
Z 'd V'Z99'0N
FREDERICK }{, KOCH, TRUSTEE
MARIA F. KOCH, TRUSTEE
.c.r
(This area for official notarial seal)
SONCH - a3AOd'-
WdEZ: Z I OOOZ ' u - daS
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 Contemporary Homes
SITE ADDRESS 52-120. Avenida Navarro
APN 773 - 235 - 006 BINNO.- J C CASE NO.: 2000-314
LEGAL: LOT 17 BLOCK 92' UNIT m S.C.@V.L.Q.
CHECKED BY: Stan Sawa 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
COMMENUCORRECTION
Compatibility Review '
b
'
Case logged and number assigned
Verify legal and APN information
V
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other Requirements:
•
•CI:� 00
IL
� .Certificate of Occupancy
� City of La Quinta
Building - and Safety Department. c�
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: 52-120 AVENIDA NAVARRO
Use Classification: SFD Bldg. Permit No.: 00,10-057
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: WILLIAM THOMAS BUFFIN
Building Official
Address:' P.O. BOX 13
City: LA QUINTA, CA, 92253
By: STEVE TRAXEL
Date: 05-03-01.
POST IN A CONSPICUOUS PLACE