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0205-064 (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 # a[[ffa�1�1 Lic. Class Ld Exp... Date s by a f ife DateF 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 ($ec_ 7044, Business &,Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to constructsthe project (Sec. 7044' -Business &" Profession`als 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. (�e) 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 t '11AX` C 7 )ggAt9.? Policy No. 2Z, 1) ' 0019— ' (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'pirovisions of Section 3700 of the Labor Code, I shall forthwith comply wit0hose provision Date: a".�^..�, Applicant •� ,r' ,f 'tel 1 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 s 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. �p Si nature (Owner/A ent) /*" r ^ �y Date?, Y ri - ' BUILDING- PERMIT PERM T# DATE VALUATION LOT TRACT _ JOB SITE ADDRESS :b ^„1li.Qd,VE!±��MAK&W"i.0 APN OWNER _ CONTRACTOR / DESIGNER / EN 1NEER�r TH0M� BURIN �'�/ VrD $,..A'�l./1NIab�0N, 110 DOX 34 4:Q« /80 HERE :I:AG DA 1A Qt:3IWA CA KIM ,HEMLDl3A DUNIES Kids. 9.2201 ('16 )4 8-,7528 ti -MV). 3724 USE OF PERMIT =012 1+A1►2ILY" DWEUITINIG �°:�" 3.�r.A?sL.JtZ, '6.'�'i',A01, SWA; OR- Sy�Lit' :i��hi,�'�8;�.!g97�[M� 1T'/� _}��.$qtt gSi�dJL7E{'vg'y'} y�?f14S. 3. 1 ]sSVYAY-✓)l',�'�{.O. CM'h'kL�'J�,4fi•Ll1:t�4 f GARAMCArsT ORT $A41AX OR W3,11414KYRD CXXT 00 (0 FRE SOMM A. V �,.5',rids'.i';�.ta�.'.'!.'�'O'!�!',fs�7leJ�3��-fltif,M-�;1�•%2t�d� �.5516.;K-� . PLAN CEIRICK. MI, 1.01-00 N-4394318 bk`ic`Hl4Rtd;1#L[ILE ..Pe'VSt0'l�it.�' d?i6fi��t,�aU�l1)i1tti: P ' ffin&)mmi$mwPEE -m3S%[) 101-.000-241016 �a13. 1r Ciit:>4DINOF(:R 4J -0EbfJ 2Q. ti 3)lB"JLe,X) )A,IVACTFllt ,5 bl,ibl , MUMUPLAN ROM /n\ &,AfCP-T. 9`1` ..• .O�'d� :!`i'��6 ;'71.'aON �!,'t+}}��j c3?��.�/�Ay�y'7� y01A��@.°'.r�.3ry�.��y FRES [� U I AID �h)e�q��f �%ayAj� 0 4.AT.tS191 JI'.Yi.1.N•1.5 FD.3'ES .9,250"'8 �i,iV U h 4�.,' iX[(' ?JFK : i _ CITYOFIP►QUIMTA-• FIIVAIdCEDEPT RECEIPT DATE, / BYy DAT FINALED � INSPECTOR z: l 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 . O L Exhaust Fans F.A.U. 0. K. to Wrap Framing _ O Compressor Insulation i pY Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath look Drywall - Int. Lath Jr Z�f Final Final POOLS - SPAS BLOCKWALL AP ROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam 7 _,2 m Approval to Cover CD -o i 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 Sewer Connection j p Z: Pool Cover Encapsulation Gas Piping Gas Test _ p Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole „r. ( • 40� 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) ..6 7 r Building Address Owner Mailing Address City Contractor AddressI/ City, 11 Of 0 134 (17 Zip W T4tyl 4 4 " P.O. BOX .78-495 CALLE LA OUINTA, CALIF 1 State Li & Classy a � 0 City Lia # Arch., Engr., Designer ny Address Tel. 4/- J�b4/ City (Zip (State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm�t I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an(7''fessi�^Code, and my license is In full force and effect.I'-L�- SIGNATURE N" � DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Susiness 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). C. 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 l 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 contractor(s) licensed pursuant to the Contractor's License Law.) 7 1 am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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 workfor 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 Exemptionyou 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 504 APPLICATION ONLY TAMPICO ORNIA 92253 0 off' f .DING: TYPE'CONNSTT. OCC. GRP. Number -7/ /i+171[_-oj 7 1 Description LDS 11s ect Description Sq. Ft. Size New ❑ No. No. Dw. Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. 0 Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback froel Rear Prop. Line Side Street Setback from Center Line Side Setback fron Property Line FINAL DATE Issued by:_ Validated by: Val WHITE = FINANCE YELLOW = APPLICANT D"ate -Apermi4 PINK = BUILDING DIVISION M Desert Sands Unified School District 47-950 Dune Palms Road Notice:. La Quinta, CA 92253 Document, Cannot Be Duplicated 760-771-8515 - CERTIFICATE OF COMPLIANCE Date 5%2/02 APN # 774-174-017 No. 23190 Jurisdiction La Quinta, Owner NameTom Buffin Permit # ° ' No'. 53835 street Avenida Navarro Log # city La Quinta Zip 92253. Study Area Tract # Lot # Square Footage 1421 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 _ 2.14 X 1,421 or $ 3,040.94 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 VIB - David Addington Telephone 408-7528 Name on the check •r By Dr. Doris Wilson ` Superintendent Fee collected /exempted by Crystal Scott Payment Received $31040.94 Check No. 264693 Signature ' F TICE: Pursuant to Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest he fees or other payment identified ovewillbegntorun from the date on which the building or installation permit for this project is sssued or on which they are paid to the Districts) or to aother public entity authorized to lect them on the District('s)(s) behalf, whichever is earlier. t 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 zpplicant 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 David Addington SITE ADDRESS 53-835 Avenida. Navarro APN i` �Y �,1'lS `D CASE'NO.': 20027635 LEGAL: LOT BLOCK UNIT S.C.@V.L.Q. CHECK .AND APPROVED BY: Martin Magana _ ; DATE:- Inform ATE: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 tOMMENT/CORRECTION Verify legal and APN information Consistent with MDG on file -(as applicable MDG filing required (5 filings since . 9/3/98) Architectural variety within 200 feet'of the surrounding area: . Colors Materials .. Architectural design -features ..... Q 0 mow d b s Commission _ Planring Other Requirements: { Ini Case Ex 0 V. Community ials No. ibit.. Nith oev. Dept. oz .�----- .M? e-56 :—._....._�.. onditions e..,. RECORDING REQUE87ED BY:. A.ND WHEN RECORDED MAIL THIS CEED AND, UNLESS OTHERWISE SHOWN ®FLOW, MAILIAX STATEMENTS TO; William Thouuwa BufEin Power Srokare B.O. 3ox 134 La Qu4nta, CA 92233 S 3 . 3s� /l�Fv'�tR-tea SPACE ASOvE THS LINI; FOR RECORCER'S JSE The undersigned grantor(s) deelere(s): Grant Deed A.P.N. 774-114-017 Documentary trensfm: taxis S { s,r) computed or full value of property conveyed, or ( X) computed on full value less valve of liens and encumbrances renelning at time of sale. ( ) Unincorporated area: ( ) City of , and FOR A VALUABLE CONSIDERATION, receipt of which is heraby acknowledged, ' MARTIN NUNEZ & IMELDA SERNA her®by GRANT(S) to tvILLIAM THOMAS DUFFLN, an urm8rried man i the real property in the City of La Quints Stele of Caiifomie, descrigad as , Courty of Riverside -I Lot 5 Of Block 1250 Unit No. , Santa Carmelita a --bale L4 Qtxlnta, as pe -r map recorded is Book Pages Df MAPS, Reccr39 Icf Riverside County, California Dared March B_ 2 0 Q 7 Signature of Gramor State of Cellrornla ) County of MARTIN NUNEZ & INEtDA SERNA On before me, i personally appeared MARTTN NuN7.7 R IM-FT,ng GFRNA personally known le me (or proved to me of the palls :f &atlsfactory evidanee) to be the aermn(a) whose neme(a) ierars subscribed to the wilhl•, instrument and aeknowledged to m• :hat he/she/they executed 'he some In hla/herlthe'r authorized eapacity(lea), end that by hls/herrtheir signatu,s(s) en the Instrument tho penon(s), or the entity upon behalf of which the person(&) acted, executed the instrument. WITNESS ray hand and ornclal Seel. 81;,nature MAIL -TAX STATEMENTS TO, ON ' y3';CH - 3171A0' NV Q l : 71 r �f O��u �r�� Cetificate' 0 1� .Y :oj . 0 City' Of La Quinta Building and- Safety Department 6 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: 53-835 AVENIDA NAVARRO Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0205-064 'Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: THOMAS BUFFIN Address: P.O. BOX 134 City: LA QUINTA, CA 92253 By: RICHARD KIRKLAND a/ . Date:. 07-29-02' Building Official - POST IN A CONSPICUOUS. PLACE