0209-213 (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 �n
.i
Date `' /�1 ��-� 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:
( ) 1, 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 ATECt,?1t�pF�143NI% Policy No. X39-g013A11f 00)9797
(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' compensationprovisions of Section3700of the Labor
Code, I shall forthwith comply with those provisions. f
Date:?' 1- •c.7 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 's
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, 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., representatives of this City to enter upon
the above-mentioned property'for inspection purposes.
-Signature (Owner/Agent)," . "'"'% Date
BUILDING PERMIT PERMIT#
0209-11.5 n
DATE VALUATION ° $90,042M
�.�p .y��� LOT / - TRACT IR X
JOB SITE
ADDRESS +gl�:-7 3 tC� .{V aA'.RU U0
APN 173-312"014
OWNER,
CONTRACTOR/DESIGNER/EN (NEER
WMUJkM iF3[JIF'aN
DAN' Y,.. AL7'TX G°I'014
227 5 AVMTMA C►i MiIWN
41 • P 80 :"rT PWTAGE DR
LA QIi1NTA CA 92253
35EfT:tu9UDA DIiJ:iO3 CA 92201
(760)408.75.25 C%. V$.
USE OF PERMIT
MXG12, FANULY .LAW ELUs G
..
1519 S. F. SIVI), .PERIMIT DOES WO f' ID1t:1,,i T& BLOCK UJM.LS, POOL OR
DRIVEWAY
TRA.OT CC,)N31'RUCTION 1,4650.511f
P ORCI-YP Y10 134,09 SF'
(41it2.A091C.A:RPORT 438.00 SF
tii�i�ATED C09T OF �:Q➢�T�'3�UCT1'f?H
90,042—V.
d,y�,�g•�y�g�+p� g; p•�; .may ��yy �7C�.
I ,li•.Y'�.iVAf1.8. i!�.7L E 4r 4.�i.Q.L1a'16®R ii
CUHST. UCTTO0) FEE '101-00.+-41$-000
PLAN C$$WX F12, 101-000-439-318
r.WDREPOS1T 101-000-439-318 -0 41,Ot1
M'ZCK AN 1CAL IrN E 101-00" 21-000 $59.00
ELEC°4I^UC;AF.YZE 101.000-420.000 $10,94
PLUib513I'NO FEE 101-00"19-000 $134.00
STRONG MOT1010 FEE- RE11M 103-000-2/0-000 $9.00
i@RAD1140 Fft 101. -OW -42.3-000 as.tw
1:SE,il'FLc7PER IMPACT FEE $2,405.00
PRECISE PLAN 101-000-441-31.3 ^ai 10.00
c"
1
•
.a'U.F'1-'I:MAL CC7NB'f YtTA`°! ION AIR) I UNI ai'Tf. ax..
S 3,<w .'3.1
I.S05 IRE -PAID MW
4250,00
RECEIPT
DATE /
+BY
DBTrFI L
INSPEC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
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 �� Q3
Vents
_
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath d
Drywall - Int. Lath _ 7– (27
Final
_
Final—
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Footings —'�
Electric Bond
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines / — i
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection --
Encapsulation
Gas Piping
Gas Test a6�
Appliances
Final
Final _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FbQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
THEESCROW' SOURCE,:INC.
44-424 TOWN CENTER- WAY .`SUITE C, PALM:DESERT -CA 92260-0000
(.760) 776-4640 • .Fax (76,0) 7764650 -
Escrow No.:. 02-3356-SASQ;:,
Jr. Escrow Officer: SARA. QUINTERO .
Date:-A'ugust'51002 w .
ESCROW SUMMARY; -
Broker.has on deposit for account of buyer $ 1,00000
Buyer will deposit prior to close of escrow $. 83,000.00
TOTAL CONSIDERATION: $ 84,000.00
Escrow holder is instructed to close on or before October 14, -2002.
TITLE/.VESTING
Buyer •to hand you-. any. additional funds:and instruments 'necessary` .for you to comply with .
instructions herein: Obtain an-`Owners/ALTA Standard Coverage. Form.policy of Title Insurance:`
from 'ORAIeTGE COAST TITLE with their standard exceptions and,provisions. This policy is
to have liability for an amount not to exceed' $84,000.00 The policy is to be issued, on real
property in the County of RIVERSIDE, State of:Califorma, a`s follows:
PARCEL NUMBER 773-312=0019,773-312-014
LOT 1 AND 26 IN BLOCK 170, SANTA CARMELITA AT VALE LA QUINTA, UNIT NO: 17, AS PER
MAP RECORDED IN BOOK 19; PAGE I9 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER
OF SACOUN
ID' TY.
a
Property Address: .APN: 773=312-001 & 773-312-014, La Quinta, CA 92253.
.The title policy is show'the-title to the•property to be vested. in:
MICHELLE EICHSTEDfOR ASSIGNEE
E NCUMBRAN CES/EXCEPTIONS,,
The policy is to be-free of encumbrances•except as follows
(1) .General and Special Taxes and SpeciaLDistnct Levies notzdue or delinquent; this will include
the lien .of supplemental taxes, if any, assessed pursuant to Chapter 498; 1983 Statutes of the
State of California.
(2) Covenants, conditions, reservationsG.includig` exceti
n ons of oil as minerals hydrocarbons,
.
( p.. �g Y
and/or lease without right of surface .entry.); restrictions,, rights of way, and easements for
public utilities, districts, water, companies, alleys; streets.
(3) Assessments and bonds of record .if any, not delinquent.
'INSTRUCTIONS'
CLOSE OF.ESCROW: .
The "Close.-`of Escrow" .shall occur 45 days after acceptance:;, Buyer and Seller shall deliver signed
escrow instructions.to`Escrow Holder within after;accep"lance.
- — DEPOSIT OF FUNDS INTO ESCROW:
Bach .'of the undersigned °hereby. acknowledges: ;and: understands ,that pursuant to State of
California Asserribly Bill , 512 ("Good Funds Legislation '). which became- effective January 1,
1990, funds deposited 'into escrow and/or deposited with the Title Company for use in this
escrow by the Property .Owner;::Buyer;or New Lender in any form other than a'wire transfer-may
cause a delay in the close'of eseroviw and/or di' sbursement-of funds at:ihe time of closing._ Each of
the undersigned hereby indemnifies and holds THE ESCROW go'- Py
f 0T 0
***SEE ADDITIONAL INSTRUCTIONS.ATTACHED HERETO AND MADE A PART HEREOF***
Initials
Each of the above signed states he has read the foregoing'instructions and-understands and agrees to them.
Date
10/11/02
No.
23723
Owner
Brackmann Buffin
Address
City
La Quinta Zip 92253
Tract #
BLK 170
Type
Single Family Residence
Lot #
Unit 1 1
Unit 2
Unit 3
Unit 4
Unit 5
Comments
CERTIFICATE OF COMPLIANCE
Desert Sands Unified,School District
4795.0 Dune Palms,' -Road
La-Quinta CA 92253
(760) 771=8515
No. Street S.F.
52755 Avenida Rubio 1465
���1FlEDSC,
Q BERMUDA DUNES
rn RANCHO MIRAGE
{� INDIAN WELLS
PALM DESERT 6
LA QUINTA b7
.QINDIO y71
0
APN #
773-312-014
Jurisdiction
La Quinta
Permit #
0209-213
Study Area
No.,, -of Units
1
Lot # - No:
Street
Unit 6
Unit -7
Unit 8
Unit 9
Unit 10
S.F.
At the present time, the Desert Sands Unified School District does not collect fees.on garages/carports, covered'patiostwalkways, 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 ifthis 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 1,465 S.T. or $3,135.10 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. 277844
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita'Green $3,135..10
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Goveynment Code Section.66020(d)(1), this will serve to riotify.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::9.50.090'6f.the ZoningCode. Its purpose is to determine: 1)
that the proposed housing��design does. hot duplicate the same architectural style of any house
within 200 feet'of the applicant, and/or 2)4 if tliere isFa need .for the. applicant to file for Master
Design Guidelines. If the ,applicant does need-�to..file a Ma's'ter Design Guideline, please transmit
this information to the `Building and Safety Department as:part of your correction' list. Please
attach additional explanations'as necessary.
0
APPLICANT:
SITE ADDRE(I
APN 7733-,-`312' 7"W0`1_ 471-4 CASE NO..: -
LEGAL: LOT 1 y`BLOCK 170'. UNIT
2002-718
S C.@V.L.Q
Martin Magana
CHECK AND.APPROVED BY: -DATE:
Inform the assigned Buildings 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 .
R.
Consistent with MDG on file I a s'
applicable)
MDG filing required (5 filings,l*
,
since 9/3/98)'
Architectural variety within 200
feet of the surrounding area:.
r...
f
•
Approved dv' _ P
-M
O Planning Commission
-Council, __..._
Architectural design features
D Dept
9M i=.
Initials 3a z
Other Requirements:
`Case No .:'ZooL -:
��� ;;=---:
0 With Conditions
Certificate of Occupancy..
�,: �
City of La Quinta � �
Building and Safety Department�°eMOF�
This -certificate issued pursuant to the requirements m. of Section 1,09, of the Uniform Building ' Code,
certifying -that, at the time -of issuance; this structure Was in compliance with thevarious ordinances
of the City'regulatin dildi construction or use. the fall
1g'A building cons owing:
BUILDING ADDRESS: 52-755 AVENOA RU810
Use, Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0209-213
Occupancy Group: A-3 -Type of Construction: VN Land Use Zone: RC
OWnet of Building: WILLIAM BUFFIN
Building Official
Address: 5.2-.275 AVENIDA OBREGON
City: kA. WINTA, PA 9253
By: KIRK KIRKLAND
Date: APRIL 16, 2003
POST IN A CONSPICUOUS PLACE