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0304-295 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Coapter. 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 112r Date �+' `a �� 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 by Section 3700 of the Labor Code, for .the performance of the work for which this permit is issued. Sed tiI have and will maintain workers' compensation insurance, as required by on 3100 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 SMTE FUND ' Policy No. 2.14- 6 019'9Td'l- (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 '('ode, I shall forthwith comply with those provisions: Date: Applicant /3 s I '� ✓li'.1s? r , - . ,: 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. 7 ,� f Ii �� r 'S nature (Owner/A ent) !'� ✓ • j ~a `'`n` 'r Date � s � BUILDING PERMIT PERMITli DATE ' VALUATIONp LOT TRACT i JOB SITE " ADDRESS��—�I di : A, R.�iMIM-- APN .� i�;�1 �.i� OWNER CONTRACTOR/ / ENGINEER 7H.0,MSXq BIRVINDA14TM L. ASI' DD4CT I°f W P.O. BOX 134 :.,, .. 41.711410 1 AGB;T5*.k 1..AQ•Uftrid CA 92253 BERMUDA.rJTW-R,3 (_4A 9220:1 , . P604.08-7528 MIA 3724, USE OF PFRMIT ' 1.560 S.F. SIO PIAER IT DOKS NOT dNMUDE FILOC1C• 'WAL.I,, 'PLI•O), OR h&N,WAY APPi?.L?"K TR,kCT CONSTRUCTION ION I;5 0100 3F CORCHIPA.TIO 31.00 S? W&RA13E:1CAR.1IOXI' 462,00 V PrKR= ` ; SUMMARY CONSTRUCTION W . .101-000418-000 gtB1%6313 PILAN CHECK i'rdrll; TO1-Ua� �P39-;�15 i15d4.99 ; FU EiPOBIT 101.000.439-318 4250,00 •MECHANICFsL.P'Lp,11 101-000-421-000 $59,00 ` RLECTRICAI, FEIN $112,34 PLIIARtlIPdC9.l ly 101-000-419-000 $174.00 "STRO1+I0 hIO'fiiON F9F - I�.E'.SI•D 101-000. 41-tWO $'9..41• ORADINit F98,1. 1-0130»42,3-63tiCi I�.00 DEVELt)I' , R IMPAC'[ :FE E PRECISE PL,&N • .., `` k "C ij©X.I Ah6I2',T,'.L., ).CREC RV LEVS PRE-PAMFE 31 42,50,00 "PEI&W FFX'S DUE NOW $3,706,75 /.. RECEIPT' DATE By DATE FINALED --------------- INSPE INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS `- MECHANICAL APPROVALS Set Backs , e.5 Underground Ducts Forms & Footings Ducts Slab Grade 'Return Air Steel Combustion Air Roof Deck Exhaust Fans O rnP F.A.U. Frame -- Few a pressor Insulation ozJ&o3 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 — �/ 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 .,Heater Final Water Piping Plumbing Final Plumbing Top Out . Equipment Enclosure Shower Pans O.K' for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Q .;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 — O Final Utility Notice (Perm) G COMMENTS: ; Date 5/29/03 No. 24478 Owner . Address City Thomas Buffin PO Box 134 La Quinta Zip 92253 CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # �q Q BERMUDA DUNES r C4 RANCHO MIRAGE �. INDIAN WELLS (fi PALM DESERT ,y cj> LA QUINTA : d'11R0INy� VV 773-292-010 Jurisdiction La Quinta Permit # 0304-295 Tract # Study Area Type Single Family Residence No. of Units Lot # No. Street S.F. Unit 1 13 52720 Avenida Ramirez 1560 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments 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 (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 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 Government Code 65995 Et Seq. in the amount of - $2.14 X 1,560 S.F. or $3,338.40 have been paid for the property listed abore 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 - David Addington Check No. 287218 Name on the check Telephone 760/406-7528 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon MCGilvrey,� $3,338.40 $o.oc Payment Recd OveroUnder Signature C NOTICE: Pursuant to Government Code Section 66020(d)(1), thi7"serve to notify you that the 90 -day approval period in Juhich 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- ApplicanUReceipt Copy -Accounting JAN -12-2004 07:15 AM P.05 w'% C Sumer roam& Plan Number Sample Group Nurnbei Sample House Number Firm: J—C, �reel HERS Provider. Street Address: 7 .t r4 CitylStatelzlp: Z4 JQu /n g Copies to: Builder, HERS Provider HERS RATER. gOMP61AN2F. STATEMENT The house was; X Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form corn y with the diagnostic tested compliance requirements as checked on this form, Distribution system Is fully'ducted (i.e„ does not use building covities'as plenums or platform returns in lieu f ducts) Where cloth backed, rubber adhesive duct tape Is installed, mastic and drawbands are used In combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections, i INIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) ` Measured Duct Pressurization Test Results (CFM 25 Pa) values i Test Leakage Flow in CFM If fan flow is calculated as 400cfmlton x number of tons enter �` -- calculated value here b If fan flow Is measured enter measured value here �j Leakage Percentage (100 x Test Leakage/Fan Flow) =. �i%v Check Box for Pass or Fall (Pass=B% or less) ❑ ts. Fail DfTHERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent dl Yes ❑ No Thermostatic Expansion Valve (or Commission approved �,.. equivalent) is installed and Access Is provided for inspection ❑ Yes is a pass Pass Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 0 Yes O No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. O Yes D No TXV Is Installed or Fan flow has been verified, If no TXV, verified fan flow matches design from CF -1 R. Measured Fan Flow r - D q Yes for both 1 and 2 is a Pass Pass Fail CITY OF LA QUINTA BUILDING & SAFETY DEPARTMENT ODM OF �771-7012 I INSPECTION REOUEST LINE 777-7153 I Owner . THOMAS .BUFFIN j. Contractor Permit Number 0304-295 POST ON JOB IN CONSPICUOUS ICBLE SPASCE INSPECTOR MUST SIGN AL - 52-720 AVENIDA ItAMIRE 4 JOB ADDRESS f 1560 S.F.,SFD PERMIT D BLOCK WALL POOL OR DRIVEOES NOT YLUDE PPROACH DATE INSP. 1 " TYPE OF INSPECTION TEMPORARY POWER SETBACKS - d� U/G PLUMBING / WASTE • . UIG ELECTRICAL / GROUNDING FOOTINGS / STEEL - CONCRETE SLAB I CRETE UNTIL ABOVE SIGNED DO NOT POUR CON!I ROOF NAIL / PRE -ROOF 1 OKAY TO WRAP • FRAMING COMBINATION ROUGH ELECTRIC i and IGH PLUMBING ROUGH ECHANICAL 0 `+ INSULATION COVER' NO WORK UNTIL ABOVE SIGNED 4 INTERIOR GYP. BD=;.DRYWALL EXTERIOR ,LATH i GAS TEST SEPTIC ABANDONMENT' i SEWER CONNECTION i SEPTIC /GREASE INTERCEPTCR I MASONRY INSPECTIONS it ..FOOTINGS / STEEL BOND BEAM i POOL/ SPA /WATER FEATURE INSPECTIONS PRE-GUNITE / SETBACKS U/G PLUMBING 'i. U/G GAS UIG ELECTRICAL j PRE PIASTER ALBARRIERS NAL'INSPECTIONS 1 TEMP. USE OF PERMANENT POWER — 'a ELECTRICAL PLUMBING i MECHANICAL i PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT. FINAL / JOB COMPLETED ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILI-IES OR OCCUPY BUILDING 4 E Certificate -TA of Occupancy . r.?- IvcaasoanTn��• • OF. Building &• Safet De 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 of ,the •Building Code and the various ordinances of the `City regulating building � - - construction and/or use. � . � � � • . •- ' BUILDING ADDRESS: 52-720 AVENIDA RAMIREZ • Use classification: SFD Building Permit No:: 0304-295, I Occupancy Group: R -3,U-1 � Type of Construction: VIV � • ,Land Use Zone: RC" Owner of Building; T. BOFFIN Address: P.Q. 60X.134 • - � � � • City,.ST,, ZIP: LA'QUINTA CA 92253 . By: KIRK KIRKLAND - � Date: 1-13-2004 Building Official POST IN A CONSPICUOUS PLACE 4 E Certificate -TA of Occupancy . r.?- IvcaasoanTn��• • OF. Building &• Safet De 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 of ,the •Building Code and the various ordinances of the `City regulating building � - - construction and/or use. � . � � � • . •- ' BUILDING ADDRESS: 52-720 AVENIDA RAMIREZ • Use classification: SFD Building Permit No:: 0304-295, I Occupancy Group: R -3,U-1 � Type of Construction: VIV � • ,Land Use Zone: RC" Owner of Building; T. BOFFIN Address: P.Q. 60X.134 • - � � � • City,.ST,,