9905-289 (SFD)F" LICENSED CONTRACTOR DECLARATION ,
1 }iereby 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 Amy License is in full force and effect.
License # Lic. Class Exp. Date
% 29 3 7,28 i3 0813V201
Signature of Contractor
OWNER -BUILDER DECLARATION
I he'reby.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).
as owner of the property, am exclusively contracting 'with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
(`)
(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.
(X) I have and -will maintain workers' compensation insurance, as required.by
Section '3700of the Labor Code; for the performance of the work for which this
permit is issued. My workers' 'compensation insurance carrier & policy no. are:
Carrier. Policy No.
"'ATE FUND � MJ-tl3U': �l�tiiQf}�1Fi
(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
workersjcompensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, i�
I shall forthwith comply with those provisions.
ate:, r ��� Applicant
,'`' .
77 . �
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 abo"ve-mentioned property for.inspectidn purposes.
.Signature (Owner/Agent) ,;=: P - Date.,.,.;,. .PIr.,r'.
BUILDING PERMIT PERMIT#
��il�cJ-1
DATE VALUATION - LOT " TRACT '
BLK 19 1`126
JOB SITS '
APN r '.
ADDRESS 54-330 AVVNII.DA tRAli'�MZ
174-2.44• 405
OWNER *
CONTRACTOR / DESIGNER / ENGINEER
TO.MAS SUPFiN �
��°ILLIAM' 1�.U5SEI..C:.ICU�1?1tS �
54-330 .AVCNIDA It IMIR.E1
50 %G JACKSON' I
LA (QUt WrA CA 91251'
THERMAL CA W2274 '
(7f )399-'1200 CB1,41' -1.954 ;
USE OF PERMIT
S1`t�C3LI FAMILY DWELLNCI
T
SrD -.fPuf MIT DORS NOT INC UDE BLOCK WALL OR POO-. MASTER c
LQ11-3A
TRACT CON- Tf RUCfIcON 1,47.5AW a•F
lai',,P,aVPAJ70 60.00 S)'
'
GARAt3FICARPORT 463,00
93TIMATED CM Or WINST.tt€ MON
1?'ERMi' ;FE8 SUMMARY
CONSTRUCTION FEL 101-000418-000
PLAN Ct'i97 X FOR (.01 -01.Y) -4_'t9-318 W_ _9 5
N1FX1b'Q3i.CA1,FM 101-000-421-000 95150
ELE/_" lilCAL FT -E 1.01-0010-420.000 fi17i1. �9
STr(ONG IMOTION FFZ - R!i"S 0 101-000-241.000 $9.00
,
ORADTNO Fi:�to1-�^lt��i-4A23-0130 swtl oo
IN�f1'C2AMARUC� i'URE FEE 21 u5 -000 -M4 -1-3Q, $1006Z
PRECISEPLAN 101-000.441-313.5 $100.00
Si M-17 f.AL CONS7RUt""CION AN.1.) PLAN CHECK
$3.37`7.19
LESS PRE -PAID FEES
$0,00
TCD"I'11.4...4'ETS!i4IT lig E&S d3R1Se;NOW
S3.3i7..i9 �
RECEIPT
DATE
By,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
ol
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
7-:(6-9 57 1
Exhaust Fans
O.K. to Wrap
( 9 5
F.A.U.
Framing
Compressor
Insulation
14
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
4
POOLS - SPAS
BLOCKWALL
A P OVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
�y7 S•
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
T
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Building
Address
Owner
maning
Address
• f��llVlfl� � ��— ��
P.O. BOX 1504 � �
78 495 CALLE TAMPICO APPL I ONLY
(D /% dr, 12,A,4f 0 ; 7�A QUINTA, CALIFORNIA 92253
City Zip Tel.
Contractor
w .
Address
City lZip Tel..
State Lic.I City
8 Classif. Lic. #
Arcn., tngr.,
Designer
Address Tel.
City Zip 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
v OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a
Permit to construct, atter, improve, demolish, or repair any structure, prior to 4fs 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.: 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, 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 I 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
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
f! I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATIONDECLARATION
I hereby 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 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.
Date Owner
NOTICE TO APPLICANT., It, 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
I hereby 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
ame
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 aGPlicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP._
A.P. Number -2 '7 Y r")fj_C®
,Legal Description L 6'7 . lel , 12,44ek- 2 9'q . Ihi I 71,-1
Project Description ` 4,4,Pr l2i494 1&7 'i 0 7- GAIL r.
-3
Sq. Ft. No. No. Dw.
Size Stories Units
New,Q Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
INT; 'tee
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line r
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Per
Validated by:a
v.'
Validation: APR ® 8 19gg
,,�� WHITE, = FINANCE YELLOW = APPLICANT'- PINK = BUILDING DIVISION
Desert.Saiiids Unified School,District
47 950'Dune=.Palms R`o`ad) '
Notice: QulntaizEA�92253
Document Cdnnot Be;Duplicated 760 771=8515
•CERTIFICATE -OF COMPLIANCE
Date 5/21'/99 AP.N # 774-244-005
No. 187.84-, Jurisdiction La Quinta
Owner NameThomas Buffin
Permit #
No. 54=330 Street Avenida Ramirez ..
City La Quinta Zip " 92253
Tract # Lot # • Square Footage
Type of Development Single Fain&Aesidence
Comments
Log#.
Study Area
1475
No. of Units 1
At the present time, the, Desert -.Sands Unified :School District does not ; collect -fees on garages/carports, covered
patios/walkways, residentfal-addrtlons.,under`500 square; feet, rdetached accessory structures pr replacement mobilehomes.
It has been determined the above named -owner, is -exempt from''paying school fees,.at this time due to the following y
reason:
EXtMPTION NOT APPLICABLE
This certifies that school -facility fees imposed',pursuant-to Government Code.:' 080 in the amount of
1.93 X 1,475 or $ 2;846.75 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 CCNalley lndependent Bank'= Mi., Shields-""00Telenhore 399
Name on the check
By Dr. Doris Wilson:
Superintendent
Fee collected1exempted-by Ellen Patino' , Payment Received 2,$4�7 00"
Check No. 195054
Signature
10TICE: Pursuant of Assembly Bill 3081(CHAP'349, STATS. 1996) thiswll serve to no4y:you that the'90<lay approval penoa)n wNch,you may protest the fees or other payment identified
above will begin to run from the date on which the,6 1ding or installation permit for this projectzissssued or on whichthey,are.paid tothe District(s) or to another public entity authorized to
:.Ilett them on the District('s)(s')'behalf, whichever is°earlier.',
l.Allec[or: Aiiacn a copy oLCOunty or city -plan eneCK appucatlon corm to aistrict. copy Ior all waivers.
Embossed Original- Building Dept./Applicant ' . Copy - Applicant/Receipt Copy _ Accounting
Apr . 2'9. 1999 10 NAM ;P.OWER 'BROKER'S
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4
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sC9m9: uasbiigCon, Str t=E
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' :RECEIVED spy RQt pRD
A7 8;8C AM
770-={e,008.5/oos-s ,
J
,tnh ate, . GRAio1'1' DEED
Tho cindesaignsd • •prsntor �,;) ded'dri f s) , - (��` �
0o umenea F 0ti � .
4�1 • !�!`-.CratlotO�C EbaTe S 0 _
„on 'iull+ ve ue oi`:prepptrtY c�w�S',0, ,or
( ) CocompuEpamputed;on Nil myo lreo 11 ens:end;onCutlSlrariCee ;emei.�inq..ne'pi(ne.b8 �kl®.
f. •) MineorporaLeO area l )'City eT ,ane
80R A HALOAAty Co z; receipt of �+lelth .is hassDy a0$norled8ed,
14ICh•ZLL8 elCRSMT. ^'Nv; tNkx AzaD' RMW
he:eliy gAA*IT(a) to
,QILLIA'4'•Pfld'!AS '809ptbi, A�'OtlkAfuZ6D MAN '
tho seal property,ln the City o!•LA QuImTA,;,County` of'Aidersidej create of calitorrll,
deocriDed ao:
LO:'& 19 AlPB .20 Ov: YtOCR-'289 .1WZT No.. , A M A CAN1tRL!?A Ar„VJLj'' LA-aOIp�, A8
?3R rte, neC�oRa�D. Zet;o00ic 20, :PAoa so. or r14p.a; ''RCCORDB 0!. n=YER63DB' Carnonr,
CA:,2POAl7IA � .•
aatod 'Jsavasy 26; 199!
ceu ntY ai --�Ativitoide.5 .- } S.s., �IiC)fBLL! elCkeTkDT
on JMu.�r*i��0} �_ may'. 4 . • Yfiro
F`�' :.•�' ; 'Dessohell o orad •
J Y pPe
Lie— ti�..•1 ��;ii aeaet� +i 'i ,
personally• known to ffa ,(op'.prevrd ,to; me ;on'
CDr Diota ol;ssti�laetocy ividencel to be
the .paroonlo'I mhoeonan,efei•,is/ace eub9cai6ed dE[(�;`�
cc, the wic)iia lnae`iNfnCt,t ;.end aeknovle ed to Yrs 3, C"nk+t CR:
me that ho/Mo/they'<�xeeuted the, 9eme n d "y; ��' < 3,
hi�/tier/ehtie auChOeiaabeCepi►eitylSerY', ebd' -AWA194
that :4Y his/her/eheTr.,oigniitiise(b): on the
ia�trun,ent}thepeYeonlit)...or tine'e�ri.y upon
baha2f_cf•which the:,_pereon(o)•socso, eiecuced,
the inetsument.
WIrnBS6 'my ren � oLlij�� 1' -est.
mstul.. 1 a
(This area far official notarial stall
MAU TAX LTA i }RLL7Ait 'rNOnilG aVseYR
SANt AS ADOW
I
J
ot---p.106anin �--Rp6yde*W.Form
RCM.stri
-fa idwellings in the, RC (Cove
This form . is to be use.d.,by.CDD staff. for review of single, mily'
ia' 1). Dist' -in,'. or th'p"'. capp'licabil-ity of: compatibility issues or need
Resident� District; der to determine..
to require the filingW
,pfa6ter'Design Guidels.-'Oy ih-e.aoolicant; It' shall be transmitted to .ine
Buildihg Safety :as yb'ur,.co . rrdc " t . ion, 1 . I'St .'Please attach additional I explanations as necessary.
APPLICANT. W. R. ROGERS.—DESEW DEVELOPMENT & RESORT
PROJECT
ADDRESS:. 54-330 Avenida Ramirez
APN: 7747244-0-05
0.
LEGAL: LOT' .BLOCK, 281 UNIT 26 S.C. @ V.L.Q.
CK'D BY:, Leslie. Pbuticwand
BIN NO: See -'Build_ CASE. -N6: 499--56 CHECK DATE:.
Inform the assi ne'd Building plan -'dhdcker,,. uponyour, assignment to this,case. The CDD
Exetutive'Secretary, maintains, a 16g,`b:o6.k. to track applications'arid assign case numbers.
I 711,�
iENT/,d6kR1E
by M CTkO,N
13E' I'lREMITIEW
Case logged and number assigned'
Verify'.legal.and -ARN..inf6rmation
Con4tent.wi'th MDG`on file..,(a�s'applidable)
MDG..filing required:,(5.+ filings -since 9/ /98
Coinsittency with street/sur"r"ounding area:
Colors
Materials
Ar ch.itedture
OTHER REQUIREMENTS:"
the.,ionino cod6-arch itectural.,and- landtcaping.'manuals, 6'nd/or.assjgned inspector should
,
be consulted W'here'.:U hc6ftainiies arise Thecompleted checklist shall be maintained in the
Building & Safety.. address file..
Certificate of cc..
C -11-t of:La?u�n_ta 3 x��
:Bu�rldrng a3nd
IS
fety Departr�en
This "Certificate issued pursuant .to ftie requirements of .Section 1.09 --of the Uniform .Bui/ding Code, h
certifying` that, °at the `time of issuance; this structure was''n comp/ranee withthe :various ordinances
- - (y ,
,Y.
- of the City regu/sting bui/ding=.construction or use:. For the,.fo/%wing ,o
BUILDING ADDRESS: 54'330`AVEN1DA ,RAM. RIZ
POST IN A CONSPICUOUS PLACE
Use Classi'f rection: SFO.. Bldg.:Rermit No.: 9905-289
Occupancy G"roupi R 3 Type of Construction: VN: Land Use,Zon.e: RC'
Owner of Building: TO<MAS BUFFIN Address: 5,4-330_:.A V;ENIPA.RAMERIZ
City: LA. QUIN, TA, CA 92253
By: STEVE TRAXEL
Date: 12-6-99
'
Building Official'
POST IN A CONSPICUOUS PLACE