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0209-166 (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 Date r �,,T. Signatureof Contractor '�-' t �� '" t `=-'• 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. $ E(x;) 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 41TATp' 1vO11WPL"r!��y 9 Policy No. 220.00 UN)T 001970 (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 Sectio) 3700 of the Labor Code; I shall forthwith comply with ,those provisions. . •Date: /'2 "�`�X Applicant`f / 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. v. 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 ; Signature (Owner/Agent) ! C f' `^ Date/ BUILDING PERMITPERMIT # DATE VALUATION LOT TRACT le) /e, - t' }.�%- S94057AW 26 17.7. t 0 JOB SITE ADDRESS 77-305 Cu'AUX DTOGXXS APN -773-312-001 OWNER CONTRACTOR/DESIGNER/EN INFER 3227.5 ANENA.0DRE4�N' 414p 13 AMIMIT,I GE DF LAiQfU45`�'J,A. CA. 922.15 .0 B)rZRNRO'UAD0MES CA, 92201 (760408=7428 CBTI# 1724 , USE OF PERMIT 1503Y, SYD PSRAIT DO ES UOT 1N%t:3091:i LICK:POOL OR DRIV 9WAY APi'k81:aAtvH. TRACT CONS TRllMION 5,519, 0!1 SP PORCHIPA110 14 3.(10 SW GARAOUCARPORY 8F yk'FYl11Jt ap) cosi or comm u mon . ':. Tir' Tr ER SUMMARY CONS T.RUCTI,ON VEE 101-000-418-000 461�1.0(I P1,AN CHECK FEE tiI1.CA F39E D KYSIT I M —00"39.318 42$0100 AdSCH : ICA:i..7 BE 101-000-42i-000 $52.50 ZLEC"TRICA'L,I?Ee 1.01-CIOU- k20-000 $111I. s3 k'k,t1 h§:Flidi� Fad? S rtOM MOTION FF.S; - R9011 J 101,000-241-000 $9.49 t fRAD1140 PPIi 101-0f39-423-000 $115.00 DEVE14PEII IMPACT FEF 0��411r.4 PRECIS: PLAN s 107-d�ttf� 7 -3ki - ; rao.Of1 w L r i` 09= 0,7=109 ,7=109 ANM P3:.AW CM, MX OCT 1 e 2902 U Mlam, P'�".� TOVIrTIMM TAX RM CITY OF LA QUINTA FINANCE D€'PT. RECEIPT DATE f{ BY D FI ED G1 TWA INS T INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade yy Return Air Steel Combustion Air Roof Deck - I Exhaust Fans O.K. to Wrap o F.A.U. Framing 3 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 �� Q-5 Final Final /y �� b Z - POOLS - SPAS BLOCKWALL APPROVALS 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 _ Q 2 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 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 (Perms �� 111c" I'll T 41q%VrW 7 -w -r .,r,;..t 4 ,..' ��;" i r i►'' Y" +i' 1 ;;i 't +e !"i` Sidi t ' a P.O. BOX 1504 APPLICATION ONLY Building `•�7 / �7, ,495 CALL rTAMPICO Address 'tom 5 i ' 1 �%� �;�}'111WTf►�CAU ORNIA 92253 _j VACY, K t UW 0/ / f? () fir �f�r Mailing Address �� J /7 City// Zip, Tel. _ y Contractor Alter ❑ Repair ❑ Demolition ❑ Address t1b _te17, !Cityf Zip/_ _ Tel. r State 0C._ City & Classif. Lc.It Arch., Engr., Plan Chk. Dep. , Designer v Const. Address Mech. I Tel. CityI Zip I State Lic. It LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section TODD) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason; (Sec. 7031.5.Business 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). Ell I, as oner 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 orimprovement 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.) 1'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 contractor(s) licensed pursuant to the Contractor's License Law.) i 7 1 am exempt under Sec. B. & 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. O 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 (8100) 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: If, 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 1hereby 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 sof this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip �r UILDING: TYPE'CONST.�?? OCC. GRP. .P. Number '7? J 12. 00/ egal Description l t?i 2 rG�/ roject Description ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side.Street Setback from Center Line Side Setback from Property Line FINAL DA Issued by Validated Validatior WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Ft. � Size !fes No. No. Dw. / Stories Units New :3'e Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. , Plan Chk. Bal. v 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 from Rear Prop. Line Side.Street Setback from Center Line Side Setback from Property Line FINAL DA Issued by Validated Validatior WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Date 10/11/02 No. 23724 Owner Brackmann/Buffin Address City La Quinta Zip 92253 Tract # BLK 170 Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units .Z O Q BERMUDA DUNES r C,n RANCHO MIRAGE INDIAN WELLS PALM DESERT 0 t}i LA QUINTA �QIN0 ,y tl 773-312-001 La Quinta 0209-166 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 26 77305 Calle Nogales 1519 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 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 $2.14X 1,519 S.F. or $3,250.66 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. 277845 Name on the check Telephone 408-7528 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green $3,250.66 Payment Recd Over/Under Signature NOTICE: Pursuant to Grnment Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting A u.9 29,2.002: 8 08A THE RSCPow sookcE, INC, AND WHEN: RE001.t9m6*lAlL-T-Qi AND. MAIL -TAX STATIONNT TO: RA T D. Ed No .5 5.98-. - -P - 21 THXN.0 NORRSIONEDGRA T D R(S) P1M-R6(S-yTHAT. DOCUMENTARYTR .00muled on ValItOPSAY PON yo#:.-cr WmPutffidbn full val too L ---'it h Un Inowporp _'QUInte Ilene And: FORA VALUABLE 0 0N.01-06RATION:'rece SAN!rA r-zfpj.jj C' the :fOIIO.wtngd'soo0bodeosl:.pro rtyin-ths'..,Cou' a , V p ntY.001d.. -MRS 14 v PA*C] M. 3.313.0 ki. 4 Tv SANTA,-CAR-r4-EL1TA AT'Va- LOT 1, AND -✓Rt.A � sr s7, IN BOO L U1W1T iTAf3E t9 OF 1VL PBS IN THR, Dente. ."A AI LEN GREENWOOD, Pr4d0it- STATE OF CALIFORNIA COUNTY OF On , .before pe.mThal.1.05 4 vi. *i2.­r%.m:Ak* mi ly , 0.oar. I � 9. ­-w11"vJXlJ'w" PerlOnally kno wn,. to ma or pto�ce tome on ttie belle c. aubscribid.to the within instrument and -a'oknow1odis dic authoylzad cgpsolty(log), on.0that.by hls/herithor sig tu WhIch the anted, Wftutsd- the WITNES3 My hand and oMolgl seal. Signature -A OtOP, OKI Siete,. fd a c ory. #040_00*16 *800N i that h d. . h'i of/they.: "00 to the 0.6n the -lmqitr.ur.n emt*thaporion(,$),.o.r.-th's.-s-niitv-upon \1 A 11 A 11 1 11 A f t' 11.1 1 1 .1 1 A .1 1 �© J' % .QUtc,�c- s�o s11�/ 2 Zs'3 <<J OfPot4� V -` w S �- : THE ESCROW SOURCE, INC. 44-421 TOWN CENTER WAY, SUITE C, PALM DESERT, CA 92260-0000 (760) 776-4640 • Fax (760) 776-4650 Escrow No.: 02-3356-SASQ Jr. Escrow Officer: SARA QUINTERO Date: August 5, 2002 .r ESCROW SUMMARY: Broker has on deposit for account of buyer $ 1,000.00 Buyer will deposit prior to close of escrow $ 83,000.00 TOTAL CONSIDERATION: $ 84,000.00 Escrow holder is instructed to close on or before October 14, 2002. TITLENESTING Buyer to hand you any additional funds and instruments necessary for you to comply with . instructions herein. Obtain an Owners/ALTA Standard Coverage Form policy of Title Insurance:`' from ORANGE COAST TITLE with their standard exceptions and provisions. This policy is to have liability for an amount not to exceed $84,000.00. The policy is to be issued on real property in the County of RIVERSIDE, State of California, as follows: PARCEL NUMBER 773-312-001, 773-312-014 LOT 1 AND 26 IN BLOCK 170, SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 17, AS PER MAP RECORDED IN BOOK 19, PAGE 19 OF MAPS, IN THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY. Property Address: APN: 773-312-001 & 773-312-014, La Quinta, CA 92253 The title policy is to show the title to the property to be vested in: MICHELLE EICHSTEDT OR ASSIGNEE ENCUMBRANCES/EXCEPTIONS The policy is to be free of encumbrances except as follows: (1) General and Special Taxes and Special District Levies not due or delinquent; this will include the lien of supplemental taxes, if any, assessed pursuant to Chapter 498, 1983 Statutes of the State of California. (2) Covenants, conditions, reservations (including exceptions of oil, gas, minerals, hydrocarbons, and/or lease without right of surface entry), restrictions, rights of way, and easements for public utilities, districts, water companies, alleys, and streets. (3) Assessments and bonds of record, if any, not delinquent. INSTRUCTIONS" __CLOSE OF ESCROW: -- — - — --- - - The "Close of Escrow" shall occur 45 days after acceptance. Buyer and Seller shall deliver signed escrow instructions to Escrow Holder within after acceptance. DEPOSIT OF FUNDS INTO ESCROW: Each of the undersigned hereby, acknowledgesand understands that pursuant to State of California Assembly Bill 512 ("Good Funds Legislation") which became effective January 1, 1990, funds deposited into escrow and/or deposited with the Title Company for use in this escrow by the Property Owner, Buyer or New Lender in any form other than a wire transfer may cause a delay in the close of escrow and/or disbursement of funds at the time of closing. Each of the undersigned hereby indemnifies and holds THE ESCROW SO'A I : ViaCopy ***SEE ADDITIONAL INSTRUCTIONS ATTACHED HERETO AND MADE A PART HEREOF*** Initials Each of the above signed states he has read the foregoing instructions and understands and agrees to them. NOV 25 '02 14:23 FR ~moi Information --w r eTo Build On E�ryireer>fng • Consulting • 'Testing TO 9-7777011 P. 03/03 REPORT OF FIELD COMPACTION TESTS TESTED FOR: POWER BROKERS PROJECT: 77-305 CALLS NOGALES PO BOX 134 LA QUINTA, CA LA QUINTA, CA 92253 DATE: November 07, 2002 OUR REPORT NO.: 073-20:303-2 TEST DATA: (1) Medium grained Silty sand. OPT: MOIST.'- 11.0 _..:.. _......—= ---- .._..._......_... TEST TEST SOIL ID MAXIMUM LAB DRY x WATERWI;T FOEIW�;ITY DRY PEIYCENT 1 COMMENTS' S eC _ -90% Mtn pNO. DEPTH ELEVATION NUMBER DENSITY CONTENT DENSITY 110.7 COMPACTION{ 1 811 FG 1 118.0 7.9 119.4 93.8 1 - A 2 .811 FG 1 118.0 7.3 118.8 110.7 93.8 92.9 94.9 1 - A ' 3 FG I 1 118.0 178-0 9.,9 120.5 109.6 1 - A 4 E8 - FG 1 10.1 123.3 122.0 1 - A TEST LOCATION: Building pad. i west side 2 I.South side 3 }cast side 4 North side NOTES: TESTS PERFORMEDDENSITIES SHOWN LbE9RpeSTNb02922-96ic 8 ASTM D3017.96 'COMMENTS: 2. BACKFILIEF,IAI B PERCENSCOM ACATION DOES Y NTH NPE OTCOM LONS WATER CONTENT; ('ercent o(dn+ weight. 3. BASE COURSE WITH gF ECIFICATIONS PERCENT COMPACTION: Basad on maximum dry 4. SUBBA E C. RETEST OF PREM JEy�Jy� TEST gg�� density obtained on sample indicated by 5: SOIL C ME VT E. MOISTURE BELOW St' OF IFI CATIONS soil ID number,6. + (1) ASTM D1557-00 METHOD A TEST INSTRUMENT: STANDARD COUNT M: D; REMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: D: Respactfully submitted, ,TECHNICIAN: Vinnie De Souza Professional Service Industries, Inc. THESE TEST RESULTS APPLY ONLY M THE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATION:, REPORTS MAY NOT BE Rfll'ROQUCEO, EXCEPT IN FULL, WITNOUT WRITTEN PERMISSION BY PROFESSIONAL.SERVICe INCLIaTRIES, INC. •I PSI A.IPO.Y (4)F Professional Service Industries, Inc. • 42-240 Green Way, Suite C - Palm Desert. CA 92211 • Phone 760/:141-5790 Fax 760/341-5794 ** TOTAL PAGE.03 ** Certificate of.Oc'c.apancy City of LaQuinta( 3 5 0. Building and Safety Department OFn '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: SINGLE FAMILY DWELLING 77-305 CALLE NOGALES Bldg. Permit No.: 0209-166 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of Building: WILLIAM BUFFIN Address: 52-275 AVENIDA OBREGON City: LA QUINTA, CA 9253 By: KIRK KIRKLAND b'L"t Date: APRIL 16, 2003 Building Official POST IN A CONSPICUOUS PLACE