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0210-115 (SFD)U) .I— CIJ LU LLI ti 6ZI� 0000 U LU W EL CO Z ME 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 #�jry yLic. Class Exp. Dyate9 °- Date (© 22 Signature of Contractor,-,r- OWNER-BUILDER ontractor-' ` 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. �40,usin� &Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractorsy%/6onstruC he project (Sec. 7044, ' Business & Professionals Code). (). I am ex(timpt9u6der/Section B&P.C. for this reason Date G) i 'Signature of Owner I WORKER'S COMPENSATION DECLARATION I hereby affic nder,r� salty of perjury one of the following declarations: () I have r i , maAitain a certificate of consent to self -insure for workers' compensatfo royi • ed for by Section 3700'of the Labor Code, for the pertormanc If th��,wol�or which this permit is issued. I have and W"v'ill maintain workers' compensation insurance, as required by �6ction 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 $TA?,19 CC°MPY3419AT) Policy No. 229-00 UNIT 00107V (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' compensatiop-provisions of Section 3700 of the Labor Code, I shall forthwith comply with, oserou{sions Date:A�2 Applicant=�_��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 fdf inspection purposes. Signature (Owner/Agent)' -�!�"7 .�` 0 Dateb ./BUILDING PERMIT PERMIT " DATE VALUATION LOT �Y.f'�.` TRACT 01,287AO 10 Bl. K 92 U-11 JOB SITE APN ADDRESS '52_2M A-V >A .> . �. OWNER CONTRACTOR / DESIGNER / EN 1NEER :1;.19C71NiAB �i't�.E01q D. A+".ID .i... ADDIN1.P7:1, N 51.370 AYE, iWi1 AO , 41-7,8p x•1�:Im��r1�"1",P,av bit. .( a�qwt3`x/' v f'"A 56253 :E4ERMODA.DVINE'S (,A 92201 s<7� CiA lig -. 21 (M-1110 3724 USE OF PERMIT it 1 1492 S.F. SYD PE MIT T)O S MOT INCf.,U11IF SL0C.1C. WA.1.-L F'OC, L OR LDRIV B:'b'7.4Y'. AP.13 kRO AC H POIRCliMFa.TIO 90.00 Sr C%ARArFlC.AT'_lf' 10.00 SF .F.S.IIVIA'TED COST OF CCXNFfRUCit0ff 91,287,40 > I UNSTh.4,14>.`T,1ON ITE 101,d1Cf0-47$400 SOMI SQ PAI�A.W C:y".1��j�ry��yy;K i� 101 101 .000-X139-�31 i$ �}:�e 3. �./1y 101-000-4,39-310 MXCHAMC:A1. FER, 101-000-42 1-0,00 M50 RIAC:TRICAL RIE 191-000-4.20-000 $109199 .P;l.,C11MfBINC! PRE. 101-000-.419-000 V16.75 27 RO14'0 MOTION FE - RESIi'.D 101.000.241.000 1�91 13 f:3Stfl.)791` G 117M.• 101.000-423-000 $15.00 DEVIelikI)PER IMPA.C'i'•f ER $2,401°00 PRIZIN1111SE pl-k14 101-000-444-345 1CJa in SMI-VXAL, f"ONS` MRUC'TT.CIMART31:'LAW C;?3k.JCX $3,91:K17 LEW PRE -PAID FEMP -W%0.00 RECEIPT DATE / f a BY'-- 0' DAT FIN D INSPECTO LC J A..) .y is • ..±�,.� : ; i - 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 — Q Exhaust Fans O.K. to Wrap , O 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 '– 10 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 I I 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 l�✓�O 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 Final Utility Notice (Perm) , . p CERTIFICATE OF COMPLIANCE �FSc Desert Sands Unified School District z4�eSl��oo 47950 Dune Palms Road BERMUDA DUNES r Date 10/18/02 La Quinta, CA 92253 Cn RANCHO INMIRAGE DESERT No. 23753 (760) 771-8515 ` _Z PALM LA QUINTA :V '117 0 O YJ o ,Y Owner Thomas Buffin APN # 773-235-021 Address 52205 Ave. Bermudas Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 52205 Ave. Bermudas 1492 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 1,492 S.F. or $3,192.88 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 CCNIB - David Addington Check No. 277865 Name on the check Telephone 760/408-7528 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen $3,192.88 $0:00 Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 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 - Applicant/Receipt Copy - Accounting 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: 52-205 AVENIDA BERMUDAS Use Classification: SINGLE FAMILY DWELLING Occupancy Group: R-3 Type of Construction Owner of Building: THOMAS BUFFIN Building Official Bldg. Permit No.: 0210-115 VN Land Use Zone: RC Address: 51-370 AVENIDA BERMUDAS City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: JANUARY 17. 2003 POST IN A CONSPICUOUS PLACE Certificate of Occupancy City of La Qdinta 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: SFD Occupancy Group: R3 52-205 AVENIDA BERMUDAS Type of Construction: VN Owner of Building: THOMAS BUFFIN Building Official Bldg. Permit No.: 0210-115 Land Use Zone: RC Address: 51-370 AVE BERMUDAS City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 1-17-03 POST IN A CONSPICUOUS PLACE