0309-263 (SFD)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of. perjury that "I am licensed under. provisions of,
Chapter 9 (commencing with Sectio-Kid00) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License#. , Lic. Class Exp. Date
682901 B �f� � �v 11d2C .
,D e! /%'. w F aN Signature of, Contractor `.. '�?� x: •� ` ""
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). r
( ) 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. -
( ) 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:
Carver. �gTATp � Policy No. 229, 0919i2f7=.043
(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
Code, L.shall forthwith comply with thosetprovislons. 1J
/Date: f!?' .�' Applicant—i' /• `�
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 t
any permit issued as a result of this applicaton agrees to, & shall, ihdemnif D
& 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 voidi
work is not commenced within 180 days from date of issuance of suc
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 informationI.T
correct. I agree to comply with all City, and State laws relating.to the buildiri
con0uction,,and hereby authorize representatives of this City to enter upon
the`above-mentioned property for'1inspecfion purposes.
./Signature (Owner/Agent) !� �r y .rte' Date`r�-t:r i
BUILDING PERMIT PERMIT#
' J-261.
DATE VALUATION , LOT TRACT
JOB SITE S
ADDRESS an"w-«�1.�' ." .A•VSN11DA. V,LAnW1>1 O 53 5ES
APN
774-124,01 '0;
OWNER
CONTRACTOR / DESIGNER / EN (NEER
THOUM BUFM _
1L.�.°�nApX�irm%BMµ�/+•iYiM r y
P.O. BOSS'. 134
A�%q�iVID
�
4 14 S0 d'd l'.JS.14t l�rAOF, Dk I
.T A QTRN TA CA 92233
BM' WDAI3UNES CA��y}�y92201 ,
ryry ,
(760)408-7528
USE OF PERMIT
M14OLE 11AMi Y DW1411ING
1498 I.F. SPO PERMIT DOWS NOT'INCIA)DE ST: CK: WAL4 F►001APA .
OR DRIV9WAY APPROACH
TRAM CONSTRUCTION 1,493,00 OF
PORCHMA'CIO 50:0 SF
0A.RAWC.ARPORT 467,00 Sty
ESTUWAIRM f~"I5ST OF CONS"I'. UMI ON
PE'fd:I nr FEE PlublMA"
CONWERUCTION FSK 101 -OW -418-000 $603.50
r
PLAN CHECK FEE ,1 O'1 -000-a 39-318 $503.32
FEE DEPOSIT 101.000.439.318 4250100
i e�I�n, �p ��l�i1 Q
1 C1A1+11•CJ�t.1..1 N 101-010*�421-WO � 09.Pr0
ELECTMAL PEE. 101 x000=420.000 3110,2"1
PLUtbiB1Nt FEE 1t11-000-419-000 $11&00
STRONG MOT iON 1r c F - RKSI i 101.000-243.10*0
OXA.17INQ PER .01-000-423-000 $13.Qr3
M.'6LOP0,IMPACT FEE 15�.4I15.D0 '
PRECISE. PIA' -N 101-000-441'-345 B 100.110.
SUB -TOTAL C'l'lI�1'SI R XXTIOI\T AND P:I.AM C JfK, . ,
$3,923..21'
e I E23,• P,A&PAJD 1*
-$250,00
TOTAL PQ=- MOS �v� NOW
OCT 2 8 2003
CITY OF LA QUINT- r'
FINANCE DEPT ') ` = •
-
RECEIPT
DATE" Z 6
BY
DAT FIN- ED
INSP C
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
vo
f
Ducts
SIWGrade
Return Air
Steel
Combustion Air
Roof Deck
�i
Exhaust Fans
OX to Wrap
—
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
-
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
7/
Encapsulation:
Gas Piping
Gas Test
U
Appliances
Final
COMMENTS:
%„o •:
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.O. BOX 1504 APPLICATION ONLY
Building �`®� �- 78-495 CALLE TAMPICO
Address �� .tom/J 1,/� L�J`� Gl' LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address , � � 3 4-/
City Zip Tel. -�
ress
State Lic. City
& Classif. 0//, / Lic. #
Arch., Engr.,
Designer.
ress I Tel.
City (Zip , (State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,9usiness 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 Ole 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. be 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).
1_2 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 1, 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'] I 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
0 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 (E100) valuation
or less.)
I certify that in the performance of thg 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: h, 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.)
Lenders Name
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
consvucti on, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signatun of aaplicant Date
Mailing Aegr,±ss
City, State, Tip
ILDING: TYP�E'CON�S�
/T.�[ OCC.
GRP.
'. Number f -7
)al Description o % /'j
eject Description F
/ _ , .i . r
Sq. Ft. /, No. No. Dw.
Size "7 Stories Units
New Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
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 from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
a WHITE= FINANCE YELLOW - APPLICANT
PINK = BUILDING DIVISION
Unit 3
Unit 4
Unit 5
Comments
Unlet 8
Unit 9
f Unit 10 -
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/waikways, 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 1,498 S.F. or $3,205.72 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 CCNalley Independent Bank - Alissa Aiton Check No. 297839
Name on the check Telephone 760/408.7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon cGilvrey Payment Recd. $0.00
i
$3,205.72 Over/Under
Signature [�
NOTICE: Pursuant,to'Govemment Code Section 66020(d)(1), this will se 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 COMPLIANCE .:
Desert Sands Unified School. District
q�o ,
�mi-
• 47960 Dune Palms Road
o
Q BERMUDA DUNES r
Date
10/28%03
La Quinta CA 92253
f
rn RANCHO MIRAGE
N INDIAN WELLS
No.
25131
(760) 771-8515
ry� PALM DESERT
LA QUINTA Z:by
INDIO
Q y�
o
Owner
Thomas Buffin
APN_ #
774-124-018
Address
P O Box 134
Jurisdiction .
La Quinta
City
La Quinta Zip 92253
Permit #
0309-263
Tract #
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1
63593 Avenida Velasco 1498 Unit 6
Unit 2
J�,3.5®5
Unit 7
Unit 3
Unit 4
Unit 5
Comments
Unlet 8
Unit 9
f Unit 10 -
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/waikways, 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 1,498 S.F. or $3,205.72 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 CCNalley Independent Bank - Alissa Aiton Check No. 297839
Name on the check Telephone 760/408.7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon cGilvrey Payment Recd. $0.00
i
$3,205.72 Over/Under
Signature [�
NOTICE: Pursuant,to'Govemment Code Section 66020(d)(1), this will se 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
5 .
585
RECORDING REQUMED BY:
STEWART'TrrLE OF CALIFORNIA, INC.
WIMN RECORDED MAIL TO.
POWER FINANCE ASSOCIATES,
P.O. Box 134
La.Quinta CA 92253
5
ORDER N0.01222143
ESCROW NO. 69237
/ �/
DOC a 2003-308944
04/30/2803 08:00A Fee:27.00
Page I of 1 Doc T Tax Paid
Recorded in Official Records
County of Riverside
Gary L. Ori3o
Assessor, County Clerk 8 Recorder
111111111111 dill 111111111 loll 1111111111111111111
GRANT DEED
The undersigned grantor(s) declare(s): A.P.N.. �,Ii.4�06
Docyineatary transfea tax is $ 9 9.0 0 city tax $ O
( ✓) Computed on fun value of property conveyed, or
( ) computed on full value less value of liens or encumbrances remaining at time of sate.
( ) Unincorporated area: ( pl) City of LA QUINTA and
FOR VALUABLE CONSIDERATION, receipt of wbict is hereby acknowledged.
ERIC S. STAHL AND CHRISTINA M. STAHL, TRUSTEES OF THE STAHL FAMILYTRDST
DATED NOVEMBER 27, 1990 FOR THE BENEFIT OF ERIC E. STAHL AND CHRISTINA M. STAHL
hereby GRANTS to POWER FINANCE ASSOCIATES, . INC., A CALIFORNIA CORPORATIO11
the following `dmaffied real property in the
vers e , State of California
qgg�AQMM,
,6: IN BMCK7-219 UNIT NO. 22, SANTA CARMELITA AT
AS PER MAP RECORDED IN_)3OOK 20, PAGE 24 OF
MAPS, IN THE OFFICE OF THE COMMY RECORDER OF SAID COUNTY
DATE: March 17, 2003
STATE OF CALIFORNIA }
COUNTY OF'S }
On 03 before mq--AAA�)
personally appeared
L
personally known to me (or proved to me on the basis of satisfac-
tory evidence) to be' the person(s), whose names) Mare sub-
scribed to the within instrument and acknow"ged to me that
l#sV/they executed the same in bfs/htri/their authorized
capacity(ies), and that by tyl' &A/thear signature(s) on the instru-
ment the persons) or the entity upon behalf of which the per.
son(s) acted, ertecauted the instrument.
WITNESS hand sad offreial seal.
.signature '
MAX TAX
AS
� INC
ERIC E. ST TRUSTE$
UND11f k�EN• • . -
Commicsiont 131i�r
Noloy
SanP_i
OMY Carom. r- 41 10d 9.206E
(This area for official notarial seal)
B Id MR'ON Nijjno Nvil11M NMI 5001 '61'M
JINN -07-2004 07:29 AM
TE OF FIELD
TION
TESTING."'
Plan Number
Sample Group Number
P-.03
Ce ing Signature ate Sample House Number
Firm: li-d" hgl-L HERS Provlder:1�6 4-' ALy4_ --
Street Address: Zr 1640 AnAnyl) d Cie CIfy/Stste/zip: _44_4n, n, rq
Copies to: Builder, HERS Provider
HERS RATER COMPLIANCE STATEM
The house was: 'Tested ElApproved as part of sample testing, but was not tested
As the HERS raterrrolvIdIngdiagnostic testing. and field verification, I certifythat the houses identified on. this form
com with the diagnostic ested compliance requirements as checked on this form..
Distribution system Is fully ducted (i.e., does not use building cavities as plenums or platform returns In Ileu
f ducts)
Where doth 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.
JG MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum. 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM Q 25 Pa) values.
Test Leakage Flow in CFM 79
If fan flow Is calculated as 400cfm/ton x number of tons enter
value here NTT
If fan flow Is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) = 5. y 1�
Check Sox for Pass or Fail (Pass=8% or less)
❑ = ;
Pass: Fail
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved uivaient.
9d"y"es ❑ No Thermostatic Expansion. Valve (or Commission approved
y
equivalent) is installed and Access is provided for Inspection)
Yes Is a pass
Pass Fail
❑ MINIMUM REQUIREMENTS FOR DUCT DESIQN COMPLIANCE CREDIT
1. Cl Yes ❑ 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. Q Yes q No 7XV 1s Installed or Fen flow has been verified.. If no 7XV,
verified fan flow matches design from CF -1R.
Measured Fan Flow =
�. ❑
Yes for both 1 and 2 Is a Pass
Pass Fail
Certificate of Occupancy
Building &Safety Department
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: 53-585 AVENIDA VELASCO
Use. classification: SF.D Building Permit No0309-263
Occupancy Group: R3 Type of Construction: VN Land Use Zone RC
Owner of Building: THOMAS BUFFIN Address: P.O. BOX 134
City, ST, ZIP: LA QUINTA CA 92253
-a, By: KIRK KIRKLAND
Date: 6-9-04
Building Official
POST IN A CONSPICUOUS PLACE