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0112-109 (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 19:5754 BI C'9 ®e�UI�C Date l 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: ( ) 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 bySection 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 � ection 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 STATE FUD Policy No. 229.00 'UNIT 0911OPP (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. /Date:!'y d , t_ Applicantif ;-a -� �� 1 �, t 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 representatives of this City to enter upon the above-mentioned property for inspection purposes. /S g ature (Owner/Agent)' — `6"'1, `� Da`te�'�` I Er r . BUILDING PERMIT PERMIT# DATE VALUATION LOT 0112-1'09 TRACT 121121400 $1(4,879DO 14 BLK 176 U18 JOB SITE ADDRESS nam A"t'xI ei idimt2 APN 174-043-01.1 OWNER CONTRACTOR/DESIGNER/EN &NEER VTi1..i: AM MWIN MI (1110NIMUT a-rioN, co 1'0, BOX 334 52 -.tea AVE' XAJ<b N OSA LAQi7,WTA CA 92253 Y.,4;Qi3�,':1:A. CA, 92253 (,760)564-3023 O`RI.4 5537 USE OF PERMIT GILD. FAIM l DIMLING SM • 1,0T 14 • t1AS;"1?1: T.AOS'. PLA14 DOESS NOT 1NCi..f.30E }Ii.JGtCK WAIAA P00JAP A OR DWEAVAY OPROA014 TRACT CONMUCTION 1,739,08Y, PORC1.11P.R TTO 54.00 sjr (tARAGFICARPORT MOP 3? E17A°Ii1 UTED COST .OF CONSIMUMP. N CTNUIRVICT1 N FEE 101-.000-418-000 PLAN CHECK laRE 101-000-439-318 PE IJkt1WIT 101.000.439-318 42$01ta 1` ECHA'NICA], PER 101-000421-000 $73,00 ELECTIOCAL F:1'_ 101-000-420-000 $119.29 Pz.tfM13Ms3T �,T!,' V42.00 STRIONt3 MO'eiOIR FEE - MID 101.000.241.000 $10.49 t1h.AiT3TflQ TETE 101-000-423.,000 ► 1 VELOPER IMPACT ME �1,�67.K7O PRE:CISR TSL hN VOV-000- 441-34:1 $100.00 CO 7 t ICr.N A'r+11 PLAN C`kiM�. $3,582.11 J ??1~ TS•k'AXil a £+�D -$250.00 �QQTT 1 '14 TM r` '1'i DUE?��►�J ��,'-�2e1 J B,Y" DATE FIfV�� INSPECTO rr';f Z INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION I DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings r Ducts Slab Grade 2 get, Return Air Steel Combustion Air Roof Deck- c Exhaust Fans O.K to Wrap TL F.A.U. Framing Compressor Insulation Z 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 �� UZ !� G`' BLOCKWALL APPROVALS POOLS - SPAS 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 V� _ Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover _ Sewer Connection �1. Z0- U" Encapsulation Gas Piping Gas Test 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 Finalt f /L Utility Notice (Perth) \w '.�+` .♦ A t'.• K YT.ir..ri"rt Y/� i:j "fY}• G,r!^S }' tiff � �.r 1 J_ .. ,�'�� Ail � � W f. l^• '.r ,+'.. ♦ �,.f. ♦ _ .. �� T1s [3P.O. BOX 1504 APPLICATION ONLY Building J 78-495 CALLE TAMPICO Address .rs'+d..-�t7ff� lJ.� r!r- a i 1`3% .o LA OUINTA, CALIFORNIA 92253 Address P. n 1 � 4 --- City Zip Contractor Address I 7 ^ C- A i_ t-'! t A lna2 P. r/J t-1S1'L State Lic. City & Classif. b _-S61 5--1 -<, 4- 1 Lic. # 3 3 Designers Lc L44 - Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION Ihereby 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 ($500). (': 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, 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 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 doesnot 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.) 17 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby affirm that I 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.) I certify that in the performance of thg 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 Ihereby 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 -of this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE'CONST. OCC. GRP. A.P. Number 'TI 4- - 2 L'O Z - 01 D Legal Description L='17) —, t+ Z S4 Project Description > t X -r , Sq. Ft. Size New No. ( No. Dw. Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ >timated Valuation PERMIT AMOUNT Plan Chk. Dep. ZJr Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Ly Infrastructure rO/c tv� 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: Val WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated Date 12/11/01 No. 22745 Owner NameThomas Buffin Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN # Jurisdiction La Quinta OV3 -0/1 ✓f&;A" t�rtl+ 774-o92 1lvr�F �S N�� lu (1 k_Z10 ( Permit # No. 53-220 Street Avenida Rubio Log # city La Quinta Zip 92253 Study Area Tract # Lot # Square Footage 1738 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 1,738 or $ 3,562.90 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 - Petra Carillo Telephone, Name on the check .P By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow Signature Payment Received $3,562.90 Check No. 259748 40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 sssued or on which they are paid to the District(s) or to another public entity authorized to tolled 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 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 of the Zoning Code. Its purpose is to determine: 1) that the proposed house design does not duplicate the same architectural style of any house Within 200 feet of the --applicant, and/or 2) if there is a need for the applicant to file for Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT PAZ CONSTRUCTION 53 - SITE ADDRESS 5-4--278-8' Avenida Rubio - APN 774 - 202 - 010 CASE NO.: 2001-5.74 LEGAL: LOT 14 BLOCK 254 UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: Michele Rambo DATE: I D� 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 COMMENT/CORRECTION Verify legal and APN.information D(, Consistent with MDG on file (as applicable of PC MDG filing required (5 filings since 9/3/98) i�l P ENS �E Ni Architectural variety within 200 feet of the surrounding area: Colors Materials Architectural design features 1 OPP, �vEp B1 C,MMUNDA�E 8y N\01 p '' CASE 10 Other Requirements: r 01/12/01 14:30 FAX 17608049062 RECORDING REQUESTED BY: AND WHEN RECORDED MAIL THIS DEED AND, UNLESS,OTNERWISE SHOWN BELOW, . MAIL TAX STATEMENTS TO: William Thomas Buffin Power Brokers R.O. Box 134 La Quinta, CA 92253 ........... . i .................. . CODIAMNIVE,'LTH TITLE The undersigned grantor(s) declare(s): Grant Documentary transfer tax is $ ( xJ computed on full value of property conveyed, or ( ") computed on full value less value of liens and encumbran 'es ( ) Unincorporated area: ( ) City of FOR A VALUABLE CONSIDERATION, receipt of which is hereby ac MIGUEL CARRILLO SPACE ABOVE THIS LINE FOR RECORDER'S USE X002 ed A.P.N. 774-043-:01-1/012 mrh, a(ning at time of sal , and hereby GRANT(S) to WILLIAM THOMAS BAA , an t nma Tried man the real property in the City of La Quinta. Stale of Califomia, describ as Lot 13 & 14 of Block 176 Unit No. Quinta, as per map recorded in Book Pag County, California I` Dated September 7, 2001 Slate of California ) County of On before me, SEL oCIARRILL personally known to me (or proved to me on the basis of satisfactory evidence) to be the parson(s) whose name(s) is/ara subscribed to the within instrument and acknowledged to me that he/she/they executed the same In tils/her/Ihalr authorized capacity(les), and. that by his/her/their sionalure(s) on the instrument 1he.person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal, Signature MAIL TAX STATEMENTS TO, I, County of Riverside Santa Carmelita at Vale La rof Maps, Records of Riverside Signature of Grantor MIGUEL CARRILLO ATHERMOSTATIC EXPANSION VALVE (TXV ainlus C3No Thentwatatic Fxpansiorl Valve (Or C:OCrlrrlissgOrt approved equivalent) is installed and Access is provided for Inspection pass Fail Yes is a pass ❑ DUCT DESIGN -- J �] Yes ❑ No ACCA Manual D Design calculations have been conVieted, Duct Design is on the plans and duct installation matches plans• 2, Yes N0 TXV is installed or Fan flow hac been verified, If Ito TXV, J verified Ihn flow matches design from CF -IR, Measured Fan Flow n ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail ❑ f, the undr,',i,mud, verity that the iibjwc diz+ttncistic test results and rhe work / performed associated with the wt(s) is in UMfonnance with the rcquircinonls 1001- conirlianco credit. [The huilder shall provide the HERS provide* a copy of the CF -6R signed by the builder cntp;oyccs ur sub -contractors certifying that diagnostic testing and installation t' ee+l he 1-1 rments for cuinpliunce credit,i l este 1iignarure, Dale Installing Subcontractor (Co. Name) UK vats General Conuactor (Co. Name) COPY TU, Building Deperrtttent HERS Provider (if applicable) Biay..dirg Owner at occLmancY CF -6R INSTALLATION CERTIFICATE 'L , A 4;4 L v'`' et t um e1- Sit, Address DUCT LEAKAGE,AND DESIGN DIAGNOSTICS UCT LEAKAGE REDUG.TION Pressttr!zation Test Results (CPM S 25 PA) Test Leakage (CFM) ,AR 17 fan Flow !f Fall Flow is Calculated a'i 400 cfmltdn x nurrt6erof-tons, or,iis 31.7 X.Hea4ng Capacity in Tltousarids of Bett�hr,`ebter calculated value here ` if fin flow is measured, enter measured value here�7'�T�� . or Fah Flow) " LeakageA'.Frtistion � Test .Leekti$el(Meesured Calculated �T-- Piss if leakage fiaction s 0.06 �' ❑ A::. r a: .'Y.a,q,1a ti ❑ For AEROSOL TYPE 5)a4►L,ANTWNLd Y - Tha following dlagnostle testing war completed. Pars Fail Duct Fen Pressurizedon at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL: )� ❑ Yes ❑ No ❑ Pressure pan test or House pressurization test �) ��j/J ❑ ❑ ❑Yes ❑ No ® vistial Inspection of Duct Connections Casa Fail ATHERMOSTATIC EXPANSION VALVE (TXV ainlus C3No Thentwatatic Fxpansiorl Valve (Or C:OCrlrrlissgOrt approved equivalent) is installed and Access is provided for Inspection pass Fail Yes is a pass ❑ DUCT DESIGN -- J �] Yes ❑ No ACCA Manual D Design calculations have been conVieted, Duct Design is on the plans and duct installation matches plans• 2, Yes N0 TXV is installed or Fan flow hac been verified, If Ito TXV, J verified Ihn flow matches design from CF -IR, Measured Fan Flow n ❑ ❑ Yes for both 1 and 2 is a Pass Pass Fail ❑ f, the undr,',i,mud, verity that the iibjwc diz+ttncistic test results and rhe work / performed associated with the wt(s) is in UMfonnance with the rcquircinonls 1001- conirlianco credit. [The huilder shall provide the HERS provide* a copy of the CF -6R signed by the builder cntp;oyccs ur sub -contractors certifying that diagnostic testing and installation t' ee+l he 1-1 rments for cuinpliunce credit,i l este 1iignarure, Dale Installing Subcontractor (Co. Name) UK vats General Conuactor (Co. Name) COPY TU, Building Deperrtttent HERS Provider (if applicable) Biay..dirg Owner at occLmancY CERTT�'ICAT OF FIELD dE FICATION AND DIAGNbSTIC Tj5TiNC CF -4P z Project Title J ,/ LR ,��3��' Bulmo Project Ad roes, Builder Cont . Telephons ten Number r eleohona mple Group Number ing Signature De Semple House Number Finn; HERS Provider: �� Street Address: �6 D C� � G1rG i City/statalZip; Copies to: Builder, HERS Provider HERB RATER CCDM 61MCE iI IATE MINT The house was: Tested ❑ Approved to part of eempie testing, but was not tested As the HERS mtg�r providing diagnostic testing and field verification, I certify that the houses Identified on this form cora 1Y with the diagngstic tested compliance requirements or, checked on this form. JC Distribution System is fu!ly*ducted (i.e., does not use building cavities AS plenums or platform returns in lieu etif ducts) here cloth booked, rubber adhesive duct tape is Installed, mastic and drawbands are used in combination with cloth b*Cked, rubber adhesive duct tape to seal 16eks at duct connections. )tIMINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostle Leakage Testing Results (Maximum 0% Duet Leakage) Measured Duct Pressurization Test Results (CFM ® 25 Pa) values Test L®ekage Flow In CFM If tan flow is calculated as 400cfm1ton 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) a. �H !V Check Box for Pass or Fall (Pass■5% or less) Pass Fall UTHERMOSTATIC EXPANSION VALVE (TXV) or Commission npprovcd equivalent A Yes ❑ No Thermostatic Expansion Valve (or Commission tl.pproved ,�^ LJ IBJ equivalcnt) Is installed and Access is provided for Inspection Yes 15.8 pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1, 0 Yes D No ACCA Manuel D Design requirements have been met (rater has verifiet9 that ectual .nstallstion matches values in .. CF -1 R and design on pian. A)� Z. ❑Yes 13fNo TXV is in8ta:fed or Pan law has. been verified, if no TXV, verified fan flow matches design from CF -11R. Measured Fan Flow = w„_,_ 0 0 Yes for both 1 end 2 Is a Pass Puss Fail Certificate of Occupancy City of La. Quinta 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: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction: 53-220 AVENIDA RUBIO Owner of Building: WILLIAM BUFFIN ^dry Building Official v ni Bldg. Permit No.: 0112-109 Land Use Zone: RC Address: P.O. BOX 134 City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: AUGUST 9, 2002 POST IN A CONSPICUOUS PLACE