0308-231 (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 B �9 ] 2/31P4.(
Date 2 , O)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 followings 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 STATE FUND Policy No. 220•• 0019707-2003
(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, Ifsshall forthwith comply with those provisions. ��/
Dat
ate: X»4 r�r 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
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 i
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 cancellatio .
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 building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for -inspection purposes.
Signature (Owner/Agent) Date/e)
BUILDING PERMIT PERMITk
-�"
DATE VALUATION LOT TRACT '
21 T l� K 59
JOB SITE
APN
ADDRESS 52 -SW AVla':'Y.I-DA 1. t'.rt,3]/iW11Y_
'7"3 -1.7.I -Ow
OWNER
CONTRACTOR / DESIGNER / EN (NEER
n710:1W a(1F17W
DAVID L. AD7DTl+lWON
]?.J. PUX:134
4I •?80 Ii 'R14rrA QE P�R
LA. QL77NTA. CA 92253
�34t"iZ'Q�,4UDJ` DUW. M' CA 99.20P e
0/ 0)408«7528 CRL0 37114
USE OF PERMIT
SINGLE FAW19 •Y DWLU1NO
1498 S.F. SFI) PERMIT DOM NOT INCI-•UDE BLC?CK 12JA .l., f 00LrS3'A
OR DRIVEWAY APPROACH, 75%REDI.ICFD 1991 1FOR. MULTIPLE PLANS OF
SAME TYPE
TRACT CONSTRUCTTO:N 1,493.00 Sly
P0RC H/PAT10 30.00 SP
"
4' A d-AGE11CkL,Ri2ORT ,. ;. "-'' . ' 467,00 OF
r
:�� carr C� cc�lat L� c�.T+r
91,15.9.653
T'MMT,M 9Ui1/i£ ARY
f
CONSTRUCTION IEE 1€3.1.000-418-000 Sttt+3.y0
`
PLAN CHECK FEE 101-000-439..318 $I25.tt<
GEE DEPOS11' '101-000-439-318 4250A)VI
MECHANICAL MME 101-(XK)-421.000
ELECTRICAL YEE 101-000.4.20.000
P1rU.Mb1.WC1'' FEE ]50.1-000-419-000 411&.09.
STRONG] MOTION F FE PE'SID 101.000.741.000 W 12
,
GRADTHO FF% 101-000-423-000 $15.00
> ..
DEVELOPER IMPACT FFX 94405.00
PRE SE PLAN ] J] -t3E f 1-3A5 $100.00
,
CONS .'RUC -n.0 . AND PLANT C"BECK.L&8
PRE-Pr"�ID n
- 2S��,Ut1'r0AL
170EX21 I.T I ;� IYUR 14.00
"FINANCEE
RECEIPT
DATE
BY
I DA IN9L D 71
INSP
r
'4 1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
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
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 "/' o
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
- i
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
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
Final
Utility Notice (Perm) -- pv
COMMENTS:
Date 8/21/03
No. 24.854
Ownft.x
Th6mds'=gu in
Addtets
I: 5x 134
Po
Ciby
Lb"6-ibuinta Zip 92253
TractI
BLK 59
P !,YP6
Single Family Residence
CERTIFICATE OF COMPLIANCE
, . . I. .
:bese'it';"'taihdi�'lUriified,S'Choo'l!:Di's.trict
47950 Dune Palms. Road
La,Minta t:-.kk253
(760) 771-8515
Lot # No. Street
Unit 1 21 51820 Avenida Ramirez
Unit 2
Unit 3
Unit 4
Unit 5
Comments
S.F* *
1498
BERMUDA DUNES
RANCHO MIRAGE
INDIAN WELLS
PALM DESERT
LA QUINTA
rf,�
INDIO_
APN #
773-171-004
Jurisdiction'-
La Quinta-
Permit #
0308-231
Study Area
No
Unit 6..
Unit 7
Unit 8
Unit 9,
Unit 10
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 (s'pac;es-th6i,d'ot4*,not*,:c,oheain facilities for living','sleeiping, c . ooking, eating or sanitation) or replacement mobile
homes. It has been determined that the: above-nai4Q'owneris exempt from paying School f6es: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., Govern hidn" t Code 65995 Et Se'q.
in the amount of $2.14 X 1,498 S.F. ,or $3,205.72 haV6,been paid for the property listed above and that
.,., I * .. 4
building permits and/or Certificates of.066uparicy, for this..squ are fo6tag6,"in this proposed project may now be issued.
,
Fees Paid By CCNa I ley', I ndep6rid."e". hiit*-13ank -bavid. Addington check No.* 287396
Name on the check
Telephone. 760/408.7528
..Yunding )Zesidential
By Dr. Doris Wilson,
Superintendent
Fee -collected /exempted by,Sharon.M6G'11vbey`.; ;Payment Recd 1$0.00.
Over/under
$3,205.72
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1);,this willserve to. notify. you that th6,90-day approval period in which you may protest the fees or
other payment identified above will begin -to. run from,t'he date, on,which the.buildin6 6� i nsti6tioh 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 authoriied to `collect them''o-n'the District(i's) behalf, whichever is earlier.
NOTICE: This Document NOT -VALID -if Duplicated
Embossed Original -;,Building Departmen . t/Applii6`a--,nt Copy,-.Applicant/Receipt Copy -Accounting
A
RC DISTRICT PLANNING REVIEW FORM
This f- iso be used by `CDD staff for review of single family dwellings in the .RC (Cove
Reside "tial)` istrict per.Section 9.50.-090 of the Zoning Code., Its purpose is to determine: 1)
that t. l p� osed housing design, -not duplicate the same architectural style of any house
y _r
within D 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 transmit
this information `to .the Building and Safety Department as part of your correction list. Please
attach additional explanations as necessary.
1
mar
SITE ADDRESS: _R9_* _W
APN T73 CASE NO.:
LEGAL: LOT BLOCK UNIT. S:C.@V.L.Q.
CHECK AND APPROVED BY:'DATE:
Inform the assigned Building plan checker upon your assignment to: this. case. The CDD
.:.Executive Secretary maintains a log :book to. track applications sand ;assign case numbers.
REQUIRED ITEM Y N COMM'ENTXORR'ECTION
Verify legal and APN.,inform6tion
Consistent with MDG on file (as
applicable)
MDG' filing required (5. filings
since 9/3/98)
#
Architectural variety within 200 O Planning; Commission
feet of the surrounding ,area: O :'ty Council
om.. u i ev.'Vep :.
Initials
Exhibit _..
C3 With Conditions
Architectural design features
Other Requirements:
6-
4
u � r
r y _
= ! Certifica to of Occupancy
0 4
L14
.cnr RATA
G . =SafetYDeartment
jo-Building &� r t
This -Certificate is issued pursuant to Ie requirements of Section .109, of the California. Building
`Code,, certifying Pthat; at thee time of,, issuance, u this structure'' was, in compliance with the
provisions of the Building Code and= the'^various -ordinances of the- City, regulating�'building
,construction andlor use. _
- BUILDINdADDRESS: 51820 "E' NIDA RAMIREZ'° ;
„ `t. - • . '• ;4 - � ' . Building Permit ,
Use classification: SFD t No.` 0308-231,,
Occupancy Group: Ri Type of Construction: + VN' Land Use Zone:,EC-
Owner.of Building: THOMAS BUFFIN - Address: P.O. BOX134
` City, ST, ZIP: LA QUINTA CA 92253,
i - By: -KIRK KIRKLAND A
d'
-Date: 5-12-2004
v f
Building Official - N
' POST IN A CONSPICUOUS PLACE
r y _