9912-148 (SFD)LICENSED CONTRACTOR DECLARATION
'whereby 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
38a S 41t t,. ��» -C'
Date
.
Date %O'6-�'Signature of Contractor / r ----
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). '
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.
(*)� 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 �`^e^ s9��, p f0.7 Policy No. �af1
u'.f.'!i! 1' VANS •• c 6;JJ n .�Y i {.
,
(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 provislons'of . ti 3700 of the Labor
Code, I shall forthwith comply with those provs
ions �.r±`�`rlA i
Date: n,.r�i) Applicant i.�%"" .• . ` e. `= .. • ._, .
Warning: Failure to secure Workers' Compensation coverage Is unlawfulta d7'
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. i
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.
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 i
permit, or cessation of work for 180 days will subject permit to cancellatiori�.'
I certify that I Have read this application and state that the above informatiori'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) Date
PERMIT
BUILDING PERMIT 12-3 F}
9912-
lljALK23
DATE VALUATION $X8;N3830 LOT, POR ti TRACT
U41
Y
JO I ADDRESS
DRESS 5'-.59ia�V.`�'�.l�10ik.�'Ifl E10
APN ��:i=®�l �Y.l ,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
S1rlti: 'AA•A.Y 1710."AS 3O:F1'+fid
1,1 Q1J1f�'d A. Cil 92253
LA. f11)IN"Iil CA 92153
cnfl Rn)
USE OF PERMIT
SINGLE FAMILY DiNFI,UNG
QST-D».Pi-I .JL4 3. DOES MOT JINC .UDE BLOCK: IMALL'JR POOL
J4 .. .
P±' RCHIP.F►:1- O 5
UA3�1.£rF:JC:Al:2i�>.'tyy�+'
r+t�-rlV��!n),.0Oi!
5 !'.J'. ,tlV 1. 10D r1*.M1CF_ 1. 0 L
M
.
a,»,r 1 /?i,Ea• A+.Ai e'c >i,. t :.E' V� v.RMVC a 16r1,
o?L RMT FEE SUMMARY
155 10tUTLON FHE 10,1-000-418-M $90100
iat qN l 3tPy1 (01-t/7yf�Z(t}�-439-/31118 �+ct93yy.i�/b}8��
I �t'4
ti"ri;`g3;
""i l i'` v,;AI.. F 3
PLtltkCf31N(i Y hM, 101-000-41y-000 5110,75
Fi'1}tf?t i{a• M(?TTt [� tiF - i2f?: ilk t()1_{>fjf)-?[il-(tf3li ��£ 81-
1 .11A T 10I<0 '101. -000 -42? -000 �^t1.t30
DEVELOPER IiL�f3CT F11M�t.yU7.tiSi
'
i:'RUX:"I ffy PLAN 101-•000-441.345 0
a 1frg�rj,att 01-#300-Q3' -:?48 •�Z5f1.n
S Y.erS� S T'REt iryFy,3
¢D,2 0.
,NrtI
y
i
1
RECEIPT
DATE
BY.
/^ //�
IUU
INSPECTOR
'
;
11
1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms &Footings�
X nz,
ar
Underground Ducts
Ducts -
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
a - Z . - aD Pj
Exhaust Fans
O.K. to Wrap
R-7- Oa T
F.A.U.
Framing
3-18-00 ST
Compressor
Insulation
3 � 13ne>0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
-t-
Exterior Lath
--C,
Drywall - Int. Lath
3 - 1 q o
Final
Final
I l a,& 1
POOLS - SPAS
BLOCKWALL
A ROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste LinesOp
Water Piping
--
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans '
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
1 - Oct
Encapsulation
Gas Piping
Gas Test
Y- a
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 —00
Utility Notice (Perm)
Building j r
Address
Owner
ua►,H,rc�
P.O. BOX 1504 AP Pti N LY v y�
78-495 CALLE TAMPICO
/� V�, • iJ1 QU�NTA, CALIFORNIA 92253
Mailing (--
Address I �. I V
BY:
J
Distances:
City
Zip
Tel.
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Contractor
FINAL DATE
L,,E v.)
L_ �. E.� :. ' ; �-
, r r_lt
Address,
^-C.; k C i
City ,. ,
Zip
Tel
State Lic.
& Classif.'j��
City
Lic. #
Arch., Engr.,.
Designer
Address
Tel.
4!
City Zip State
A J Lic. # J
LICEN$ D CONTRACTOR'S DECLARATION
I hergQbY affirm that I am I ce sed under provisions of Chapter 9 (commencing with Section
7000) 6f Division,3 of the 135s'ness and4 ofes9ions Cod ; and my license is in full forc/ee and
effec�C'J si�.c� �>4SP �'' Gt;E:+ti--�'
slf,NATIlAr i `-. i 9 L=.Jr!Y' `^` / 'l nATI
I hereby affirm,that I am exempt from the Contractors License Law for the following
reason: (Sec. 703/1.5, 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 fhe applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of thG Business and Professions Code, or that. he is exempt therefrom, and the basis
for the aIle% d exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the plicant to a civil penalty of not more than five hundred dollars ($500).
I': I, as owkier 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.)
1 1 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.)
11 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I herebyaffirm 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
n 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.)
Icertify 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
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 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONNST.. /OCC. GRP._
A.P. Number / / 3
Legal Description &t., —F 1J 7t, 6e,-1 Z_
Project Description
Sq, Ft, No. No. Dw.
Size ill Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
O
PERMIT AMOUNT
Plan Chk. Dep. O
Plan Chk. Bal.
Const.
Mech.
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 = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Date 1/20/00
No. 19927
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameWilliam Thomas Buffin
No. 51-595 Street Avenida Rubio
City La Quinta
Tract # BLK23 U2 Lot # POR 2
Type of Development Single Family Residence
Comments
APN # 773-121-011
*Jurisdiction La Quinta
Permit # 9912-148
Log #
Zip 92253 Study Area
Square Footage 1,397
No. of Units 1
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
1.93 X 1,397 or $ 2,696.21 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 CCNalley Independent Bank/Patty Manana
Name on the check
By Dr. Doris Wilson
Superintendent ,
Fee collected /exempted by Mary Ann L. Borja
a
Telephone 760-5644866,.
Payment Received $2,696:21
Check No. 209574
Signature d
[No
TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90day approval period in which you may protest Ne fees or other payment identified
bove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
ollect 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
DEC. 2.1999 9137PM COMMONWEALTH NO.145 P.1i1
RECORDING REQUESTED BY: i
CRICAGO TITiA Com iy COMPANY
99.9354KC 9705 S25
WILLIAM THOMAS SUFF N a
,
LA QiJRSNTA�aCALIFORNMX 92253 ' P
SPACE 612VI T'MISf LYREC R'S USE
AFN--121411
dx'"T DEED
The undersigned gra We) declare(s)
Documentary transfer tax is $9.90
(XIX) Computed on ftt 1 value of prop0 ty Conveyed, or '
i Computed on fu 1 value lose Ile and encumbrances remain ng at time O!' sale.
( )
Mg
( ) City of and
FOR A VALUABLE CONSIDSUTION, receipt �o!'erhiCh is hereby acknowledged,
3TBv8iQ !lCTiiT,
1
hereby GLV't'(s) to I'
WILLIAM THMIU DBA LA QCJINrA, P I�
ARTNBR$
the real property inIthe City of LA Qtj8XTA, County of Riverside, State of California,
described as: r
Lot North 1/2 of Lot �, Block 23, Onit No, 2, Tre,Ct.Santa Carmel to at vale La Quints, as
per map recorded inok ie, P498(s) 54-56 inclusive of.maps, in the office of she County
Recorder of said Co y, ;
Dated Noveater 8, 199 6
State ofCofttprnft
w I
,Co O! I AtGG } IS • S , $V$�1 HDRT
on
beform.me,
personally app red
1 5 t
Personally known to me for proved to me,on
the basis of satisfactory evidence) eo be ?11
the person(jo whose ne}me"(,1() is/ sube�ribed IR16 LAC KORO
to the within-instru Rot#RY PU®LIC - OREGON
tn�nt acid aekAowledged to Co ISSION NO. 310577
me that he/
ANAMy executed the same in i><PIRic tAl� 10,1oD�
hie/**/ttAr authorized capacity.("),! and '
that by hie/ljW/tA4r signatureml' on t e '1
instrument the person(kj, or the entity upon ! '
behalf of which the person act x
(x) ed, a ecuted
the instrument. + f
ws 9 my h and o! is �.
Signator
MAIL TAX STATEMENTS TOL (This ,area tor.ofticial noq al sal)
� ;�
I 'd 9218'°N I S83NO89 HAOd NV80:01 6661 "Z '380
ATTIC AREA: 1,397 SQ FT r '
519- SQ FT
TOTAL 1,916 * SQ FT
1,916 SQ FT / 300 _ 6.39 SQ FT REQUIRED
4 VENTS / 14" X 18" VENTS (1.17 SQ FT X 1.5 SQ FT)
2 ROUND VENTS / 2' DIA. VENTS
4X1.17SQFTX1.5SQFT= 7.02 SQ FT'
2X3.14X1.2 = 6.28 SQ FT
TOTAL 13.30 i
LESS 50% VENTED AREA
.6.65 SQ, FT.
._.....- - -- ._ . .._
...
ACTUAL NET TOTAL,SHOWN f
6.65- SQ<F:T `
_
..
':- PLAN.SHOWS (2) 2'aDIAMETER & (4)`14"•X 18"
VENTS
s
_
LENDEL: EXCELWY DOCS\CALMAT-m LQ PLAN
r I'
11/30/99
LQ
LA QUINTA PLAN •.
ELECTRICAL LOAD CALCS
'DESCRIPTION " `
CKT =,
-y VOLTS
_CKT
AMPSF.
ANO. OF
UNITS'
VOLTS -AMPS
PER`UNIT
. ; 'TOTAL, ,
„VOLTS -AMPS
`
120. V. MULT OUTLET CKTS
GEN LTG @ 3 W PSF
120
-15 1,397'
3 4,191
SM APPLIANCE CKTS
120
20 2
1,500
-3,000.
GRI CKTS
120
20 : - �' - 1
_ -1,500
-1,500
SUBTOTAL
. 8,691
120 V -SGL OUTLET CKTS
DISPOSAL
120
20 1
2,400,
2,400
DISHWASHER
120
20 1
2,400
2,400'
LAUNDRY
120
20 1
.2,400.
2,400
HOOD ,
120
3 1
360
.360
'.SUBTOTAL-
7;560
FIRST 10,000 V=A @.100%
-
P
10,000
BAL- V=A ..@ 40%
2,500
SUBTOTAL
_.: _.
"
.12,500
RANGE:
23:0
9,200:
9;200
A/C (LARGEST FAU OR A/C)
' 230
;-`30 ` v.'.--'.:,:;1:
;:.` ' ' "= 6;900. • ;`.6;900
TOTAL V-A
n
28;600
SELECT SERVICE SIZE: TOTAL V-A
`230 VOLTS
X28,600
' 230
.124.3
AMPS
LENDEL: EXCELIMY DOMCALMELEC LO -
w • ` �„ .� . - • -s � • 11/30/99 _ ,
Certificate of Occupancy
City of La Quintal
Building and Safety Department
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:
Use Classification: SFD
Occupancy Group: R3 .
51-595 AVENIDA RUBIO
Type of Construction:
Owner of Building: WILLIAM THOMAS BUFFIN
Building Official
Bldg. Permit No.: 9912-148
VN Land Use Zone: RC
Address: P.O. BOX 134
City: LA QUINTA, .' CA 92253
By: STEVE TRAXEL
Date: 05-15-00
POST IN A CONSPICUOUS PLACE