0309-015 (SFD)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
682901 13
Date C/ ��� Signature of Contractor f
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 S•1'A.TE FUk41: Policy No. 2"- 0019`10"!•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
Code, I shall forthwith comply with those provisions. /
'bate:' i 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 & 4a6h 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 employee
2. Any permit issued as a result of this application becomes null and void D
work is not commenced within 180 days from date of issuance of suc
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 i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize. representatives of this City to enter upo
the above-mentioned property for inspection purposes. 1`
Signature (Owner/Agent). Dateyni /--e, ?:
BUILDING PERMIT PERMIT#
0309-015
DATE /v�ALUATION LOT TRACT
�''✓`l $1.13,81.7.00 it
t' ..>
JOB SITE
ADDRESS 5"45 AVE A. CARP"MA
APN
774242-021e
OWNER
CONTRACTOR / DESIGNER / ENGINEER ,
TF HUM BL94W
DAVID LAI3S W(T*T014
A0, BOX 134
41.180 BERM. AGE DR
LAQUEp rA CA 92253tM1TDAD%1F��
CA 92201
('760)408-7528 0B1,4€ 3724
USE OF PERMIT
11Thi'C1U F'Al .11LY DWFI .T WG
1914 S.F. SPD P1aiZ.MIT DOM NOT INCLUDE LiL)OCK WALL., POOL/;PA
OR DRVKWAYAPPROACH
TRACT CONSTRUCTIOAI 3,914.00 OF
POR.CHWATIO 36,00 SF
GARAWCARPOR`.1' 480.00 3F
t'7F C'OI'tS'� 'WenoN,
yy T•� y�y�ry/�Q pR'��L"AiVTi1TLM'C.CD1v'".['
lti�h YKE S'IJi.Y.L'.L7.ib7.[LI
CONSTRUCTION FRE 101-000-418.000 sass.s®
PIAN C13WK FEE 101'000-439-3418
FRE DEPOSIT 101-000.439-:318 -6260.00
MRCkiA,NICAL FEE 101-000-421..000 $65.:50
ELI&CTR3CAL FRE 101.000.424.000 S125,09
PLUMBING FEE 101-000-419-000 $1411,00
STRONG MOTION FF:E - RES1D 101.000-241.000 $11,38
)MRAs, N0 FEE 101-000-423-1100 $15.00
'IEVEWPFR IMPACT FFX 5245100
PRECISE PL.A14 101-000,441-345 $100.00
.
KM.TOTAT, C:Old9T UC'TIOR ANIS PLAN C.',HWK
$4,123.90
LESS PILIS-PA►.D F
-$250:00
IVIAL F'1l:0W.11i1XS DUNXC3+W
.aa
""77310
Sri' 16 20103
J
CITY OF LA QUINTA
�� By<7 =ATrINSPECTOD�'.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
^v
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/Z -L- O
Exhaust Fans
O.K. to Wrap X
lvoF.A.U.
Framing
Compressor
Insulation
a S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int, Lath
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
steel
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
0. K, for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
TSG
Encapsulation
Gas Piping
Gas Test
_
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 r
Final
Utility Notice (Perm)
COMMENTS:
CERTIFICATE OF COMPLIANCE � FIFD
Desert Sands Unified School District z��o
47950 Dune Palms Road Q BERMUDA DUNES r
Date 9/16/03 La Quinta CA 92253 C/) RANCANWEL S d
! �. INDIAN WELLS '1
No. 24975 (760) 771-8515 V-PALM LA QUINTA �y
YO INDIO
m Y
Owner Thomas Buffin APN # 774-242-021
Address P.O. Box 134 Jurisdiction La Quinta
City La Quinta Zip 92253 Permit # 0309-015
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street S.F.
Unit 1 11 54445 Avenida Carranza 1914 Unit 6
Unit 2 Unit 7
Unit 3 Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments
Lot # No. Street S.F.
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 1,914 S.F. or $4,095.96 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 CCNIB-David Addington Check No. 287443
Name on the check Telephone
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia
Signature
Funding Residential
Payment Recd $0.00
$4,095.96 Over/Under
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 - ApplicantlReceipt Copy - Accounting
APR -28-2004 07:05 AM
P.01
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -411
Project Title pa
40-41(a-15 pown Z-.1 0
Builder Name
Builder CO I t Telephone Plan Number
HE R§,Rater Telephone Sample Group Number
ify-jf-'4na Lure Sample House Number
HERS Provider,
$(root AcOe4•;., 4LI&L KI C&6.a --cityistitemp- OwInra !ce'7L2S3
Copies to- Builder, HERS Provider
HERS RATEPjaOMELIANCE STATE MEbLT
The h"e was: Tested Approved as Part Of'sample testing, but was not tested
As the HERS rater providing diagnostic testing and field veiiftatlon, I certify that the houses identified on this form
corn with the diagnostic tested compliance requirements as checked on this form.
Distribution system is I fully,clucted (Le., does not use building cavities as plenums or platform returns in lieu
f ducts)
-
I W here cloth backedr,rUbber adhesive duct tape Is Installed, mastic and drawbands are used in Combination
with cloth backdd, rubber adhesive duct tape to seal leaks at duct connections.
4Z1MINIMUM 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 fen 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) Zo
Check Box for Pass or Fail (Pass=6% or less) ppr❑
ass Fail
ZTHERMOSTATIC EXPANSION VALVE TXV) or Commission Uproved equivalent
uYes ED No Thermostatic Expansion Valve (or Commission approved
equivalent) is Installed and Access Is provided for inspection
Yes Is a pass Pass Fail
.0 MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1 n Yes 0 No RCCA Manuel 0 Deeign requirementa have been met
(rater has verified that actual Installation matches values in
CF -1R and design on plan.
2. CJ Yes 173 No TXV is Installed or Fan flow has been verified. If no TXVI
verified fen flow matches design from CF -1 R.
Measured Fan Flow
13 E3
Ybs for both 1 and 2 is a Pass Pass Fail
�-- Certificate of Occupancy0
11
Lrnrotnm4�� .
G� OFTBuildin & Safet Department
9► Y p
This Certificate is issued pursuant to the requirements 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 andlor use.
.BUILDING ADDRESS: 54-445 AVENIDA CARRANZA
Use classification: SFD Building Permit No.: 0309-015
Occupancy Group: R3 Type of Construction: VN Land Use Zone: R-3
Owner of Building: THOMAS BUFFIN Address: P.O. BOX 134
City, ST, ZIP: LA QUINTA CA 92253
J-•�� By: KIRK KIRKLAND
Date: 5-5-04
Building Official
L
POST IN A CONSPICUOUS PLACE