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0403-211 (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 , 7, Date' J7 t1 Signature of Contrac 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. t(��) 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 STAT& QUND . Policy No. 1733735"03 (This section need not be completed if the permit valuation is for $100.00 or less). J ( ) 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 Cal ifornia,�and`a'gree that if I should become subject to the workers' compensation provisions of Se.cttion.3700 of the Labor Code, I shallJforthwith comply with `hose Prov ions Applicants 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, 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 represetntatives of this City to enter upon the above-mentioned prope rt ffresnspection'p:u�rposes. Signature (Owner/Agent) L`"P F' Date BUILDING PERMIT PERMITr DATE VALUATION LOT TRACT 01.11.59.60 7.0 JOB SITE ADDRESS a.1-100 AV .MWA RUEQO APN 74-04'3 �i '}�ty, i. ! OWNER CONTRACTOR / DESIGNER / EN (NEER POW L, R .FJNAN(,T- BRAUC W1.i1R1 WC P.O. BOX 134 50-555 "NAM11:NGTON ST -4-227 LA QUWrA. CA 92253 l''rr�i#Yy/QryUINRTAg�g6�C[ t."A 9y22253 Cyy ('760> 5-97.$69 MIN, 387 r' USE OF PERMIT BIIe401 I, RAM.T. Y DWK:a:NG g 1498 S.A. SFD PERMIT DOES NOT INCLUDE BWCK'VvTA1A, POWSPA. , OR I)Ii1V I WAY APPROACH TRACT CaRSTRUCTION 1,4943.00 3F PORC1 IPA T 10 50.00 sp 0A.1LAI:183C.M2PORT 40100 8F 'tom f� MMA ED C06` OF CONS7R€3C•°l:.[ON F, '.LN3I1" tF7E`F "MARY - CONOTRUC."; IOW WE 101-000-418.000 HOMO - PLAN CHECK FEE 101-000-1:39-318 ITZ U&POS1T 101-000-439-318 42".00 MEC1ia NICR.1.• FI,?F 101-000-421-000 $60.00 &LCCTRICAI. FEE 10 i -000-420.000 $110.27 i PLUMBING f%�13 101-000-419-0041 S'TRONO MOT10A PC& - k1;.,",IU 101.000.241-000 X9.12- GR.AL)rNO IM—E 101-000-423-000 $19.00 DEVELOPER IMPACT FEE �?4124,413 •; P11-2 ISE PLAIT 101-000-441-345 -,. 90B -TOTAL CONWIM -1014 MM PLA14 CHFCK $3,9,U.46 1 `3:3 PR73-PA[D F`1TES -s3.St cjo "FINANDE RECEIPT DATE BY f D�FINALEDO` INSP TOR 6 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Slab Grade © ,� r Ducts Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing 7 v Compressor Insulation _Z d 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 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines ? —6 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection U Encapsulation Gas Piping Gas Test 2 Appliances Final COMMENTS: Final Utility Notice (Gas) y f1 �jvf' 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 O'2Q'0 Final Utility Notice (Perm) Gib At the present time, the Desert Sands Unified. School District does not, collect fees on ,garages/carports, covered, patiostWalkways, residential additions under 500 square 4eet, detached accessory structures (spaces that "do not contain facilities for living; 'sleeping,;gooking,, eating or sanitation) or replacement mobile homes. It has been determined that the above-named;owner is ezerripi 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.Govemlient Codei65995'Et Seq. in the amount of $2.24 X 1;498 S.F. or' $3,355.62 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 =4113 Bank, Mike Brauckmann Check No. 305387 Name on-the'check Tetephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted `by -Patricia Barbuzza Signature Payment Recd 1$0.00 $3,355:52 Over/Under NOTICE: Pursuant to GovemmenMode Section 6602% this willserve td�hotlfy,you that the 90.day approval period in which you may protest the fees or other payment identified above w'il(*_ imto.run1 omjthe 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 Dtstrict('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if ,Duplicated Embossed Original - Building bepartment/Applicant Copy - Applicaitt/Receipt Copy - Accounting M 3ECORDED MAIL TO: Finance Assoc. Inc- .ifornia Corporation Box .134 iinta, CA 92253 � 3 400 A%,ze �. 773 293-.001 MARY TRAN9Ff:A TAX $..................................:........„. SPACE ABOVE T-1-118 UNE FOR RECORDER'S USE wted on the consideration or value,of...property conveyed; OR Luted on the consldemdon or value'. less Rens o : encumbrances Jning at timeaf sale. stgnatura of.De arant or;Agem e g rex — Firm Name G. RA.' T' S EED VALUABLE CONSIDERATION, receipt ol"which 1s hereby °aclmowledded, B. Ortega, .a married . man” as. his soleand separate 'property. GRANT(S)to William Thomas' Buffin -,a married, ,man as his -,sole and -ate property, and Power`Finance`: 'Associates, ' Inc.' ' '. a • California Corp_ I property in the City of La Quinta of Riverside , State of California, described as 3 Block 152 mb 0.18/099 Santa Car-mel-ita Vale La•.Quinta Unit #16 a0 "B.lock .1 T6 mb 019 / 0:3-U�Santa C rmeli to,:Vale L!a _Qunta Unit #4 8 January 26,2004- )F 6,2004)F CAUFORNIA }ss. 3S my d aRidat po, ['e TAX'STATEMENTS TO: EAN7A`COtZ1EZ _ Co "b5lon #'1414446 •.;� "`' NotoryPubtic-Califomla Rlderslde;County My Corium, Exples.Api 29.2007, DEC -08-2004 05:46 PM CERTIFICAT P.01 STING CF.41111 lh-eL Sullder Name Olan Number $arhpls Gro0p,,Number irytnq Signature D Sample HOUas I i Number HERS..Provider; TC. vLA5&_-IA� Street Address: :For/ r1i4ZLI Citylst.atelzip: COPiO5 to:. -Builder, HERS Provide'r. HERS RATE R -COMP L16NCE SI&TEMENI The house JO—Tested ❑ Oproved as part of sample testing, but was not tested As the HERS rater providing qlapostIc testing and field v4i1flcatIon,.I'rceltifY that the houses identified on this form comply with the diagnostic tested co ' mplia,nce rdo0l.remants as Checkadon- this form, Distribution system is fully'ducted (Le., ddes' . not use building cavities 'as plenums of Platform returns in lieu of ducts) Where cloth backed, rubber.edhosive duct tape Is Installed, mastic and drawbands are used In* combination with cloth backed, rubber adhesive duct tape to seal lii;, ea. 9 of duct connections, ,MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT uc agnoslry I-ea!K11199 Testing (M8xlmum,6% Duct Leakage) Duct -Pressurization Test Results (CFM @ 26 Pa) Measuredvilues Test Leakage Flow In CFM .If fan flow Is calculated as-400cfmihon xnum6er of ions, enter calculated vai�q here /V/ lffariflow Is measured enter measured red value here Leakage Percentage (10.0 Tes't.l."eakage/Fan Flow) Check Box for Paisor. FaIj (06SS'4% of less) Fail i THERMOSTATIC EXPAN Sid N VALVE (TXV) or Commission approved equivalent _� ;eyes No Thermostatic' E xPansion Valve" (or Commits !on, approved equiyalenO lsln's'tilled-,�rid Acc'dss is provid,06 . for"inipection MINIMUM REQUIREMENTS -FOR DUCT DESIGN ass Fail N,�,,COMPLANMCREDIT 0 Yes M No ACCA-Minoal D Design re_'i'u`jr`,e-1�nents have. been h; 'met .,(r ' ater has va-'riti'ed'thg'i"ictual"��Installatl'O'n m a'tc' 166 `�'Vakues In CF -1 R'and design 0"ns"PI irk, 2. 0 Yes 0 No TXV is.installed,or Fan flow has been. verified, If no TXV, verified -,fan flow matches design troirn CF -1 R. Measured Fan Flow= C3 Yes for, both 1 and 2 is a Pass Pass Fail l�� ;: � �- S, 2� �.�� -- �� CiTY4 LAf0UINTA tB'L,J'JLDING,& SAFE TY.DEPARTMENT cFaF 'r ' `c+`o 777-701,2 _ c;,�NSPECTIONBEQUEST LINE ,1 2.j 777=7153 jpQ ,EIt.FINANCE . OWneC t i BRA[fCKMANN INC: z : - ContraCto I' L =' 040X-111 �lu Permit ber' POST ON•JOB'IN CONSPICUOU.StPLACE ' INSPECTOR MUST SIGN ALL APPLICABLE SPACES 53=100 AVEiRU BIO •' JOB ADDRESS 1.498 S.E. SFD PERMIT DOES' NOT�INCLUDE R BLOCK WALL, POOL4A',O-D1tIVEWAY APPRAOCH TYPE OF INSPECTION DATE INSP.,, TEMPORARY POWER SETBACKS tiff ..dam. U/G PLUMBING;%.WASTE. U/G ELECTRICAL / GROUNDING FOOTINGS / STEEL CQNCRETE-SLAB ..:> , ` ; .:�,� k• .axe :. ; DO'NOTP,OUR`6CONCRETE UNTIL -ABOVE SIGNED_ ' ROOF NAIL /-PRE=ROOF' OKAY TO WRAP`'` FRAMING CQMBINATIb:N Kx ROUGH ELECTRIC ROUGH'PLUMBING"..' ROUGH MECHANICAL' I INSULATION COVER'NO WORK UNTIL'ABOVE SIGNED. INTERIOR_GYP°BD. DRYWALL" EXTERIOR LATH GAS TEST. SEPTIC ABANDONMENT SEWER,CONNECTION D v SEPTI' /,.GREASE. INTERCEPTOR i -MASONRY INSPECTIONS FOOTINGS/ STEEL - BOND BEAM POOL / SPA,/ WATER FEATURE INSPECTIONS`, PRE-GUNITEJ SETBACKS'. . U/G PLUMBING, U/G GAS U/G. ELECTRICAL. PRE PLASTER`(ALARMS/ BARRIERS FfNAL,INSPECTIONS TEMP. USE OF PERMANENT POWER �. ELECTRICAL.. PLUMBING MECHANICAL.. ,* PUBLIC'WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT. FINAL / JOB COMPLETED ABOVE APPROVALS DO NOT'INCLUDE RIGHT TO TURN'ON UTILITIES OR'O.000PY BUILDING 4 Certificate, ®f Occupancy 4 AtOF Building & Safety 0, artment 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 .1 Building Code and the various ordinances of the City regulating building x construction and/or use. BUILDING ADDRESS: -53-1.U:0 AVENIDA RUBIO kt s Use classification: SINGLE FAMILY DWELLING €l ' Occupancy Group: R3 Type of Construction: VN Owner of. Building: POWER FINANCE Building Official A CONSPICUOUS PLAC Building Permit No.: 0403-211 Land Use Zone: RC Address: P.O. BOX 134 City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: DECEMBER 9, 2004 "'1}1;141>.