0101-204 (SFD)i -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
Signature of Contractodo,
OWNER -BUILDER DECLARATION
I hereby affirm under penalfy. 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). .ri -
( ) 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 f6r'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:
Carrier Policy No.
(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, I shall forthwith comply with thiosetprovisions.
,,"Date:, Applicant-
Warning:
pplicant 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..E
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, ind@
& hold harmless the City of La Quinta, its officers, agents and empids�
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 permithto.,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-me•'rifioned property for inspection purposes.
Signature (Owner/Agent) VIA. Date's + '•
µ
BUILDING PERMIT.PERMIT # /
DATE VALUATION] LOT TRACT
)��;)�[j6�
!. g/ a� q y��y �/ y(�q pyo
�y3.51
•-h lr 1. f -i l _v , 33�71Q 6 .r1LIK1�.l.8A 1./M
JOB SITE ' 7 V' ` - -- c,
APN
ADDRESS
S44WAV M,'Cf3A. Val-iff'4Cb
OWNER
CONTRACTOR /DESIGNER /E fNEE -
igQ�R{Cfk `:�}�+Wyk'CfJR•pa�%Jg3.'�y'�f�T>t•3{€��p .,.,?
G7�D�2'ed°f�A��pZ"��ti3��.�ty�gtYpL��fp
'S Z 3 0 .&'��C �.nA9'.'..�CBBA'iS•6tY.d\.D,5`t3
gyp'.
S S 3 0 A V ,�.�n�'�Ali.�A L�3r�a,YYAtllw AP '
ut Qpam CA 92233
iA'*ti+Lra#"1"�k Ply 92253
C?4S3} i.w13t!S2 k"l�t 6255
USE OF PERMIT
OIlMU,FAMMY73'ti F,'I. 4
VD • PERMIT FOES NOT INC'O,;UDBP IiWC, .K IYAL4 '6 001, Oa Di8JYVWAY
i
fRA%eCONSTRUCTION 1,42L.0000SIP
CORCi44A }O 36.0 F S
OAR,A.QWCA PO[ T (M'1) 4,99h.f38
5 PT.W000 JACK 2013:08 LTA
'r'.if 4.1XMfCOST OF C'C3NMUCTION
89.3w.10 ..
FEE 10)-000-410-000 094,50
PI.AN CHECK 1W 101-000-439-319 $: .12
MUCH"ICAL FIX 101.41 .421-C?00 SAW
MLECT1UCA-L FXE 101-000-420-41= $129.44
'1IL•UMW-10 Mfu+ . _ A 4I.000.4) 9-000 V 10; In,
STRONG MOTION 1r1:P, - RESILl 101.000-24.1-000 Sa. a3
( R.ADF1<10 FEE 101-000-423-000 �2Q•P3Q
S: n MI.A)P.9A IM, PACT 1ER $1,9noo
PUMP 0'19 .f a44 SV 101 -000 -441, -?45 $100.00
FEE rWl'Caul'1' 101-000-439-318 v�x:�i9.fi0 •
,,• .,
14: : 20 C 1,Ceti-AL CfaMisc� aow 1,1,m a te
$3,430.74
RECEIPT
DATE j
J l
BY /
/ _7
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_ _
��f
I
Underground Ducts
Forms & Footings
_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_C 0�
�"�
Exhaust Fans
O.K. to Wrap --SDI
T'j T
F.A.U.
Framing
I
�L�
C�7
Compressor
Insulation
C ��
ay"'�,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior lath
Drywall - Int. Lath
� � 3G O �
/�
�
Final
Final
l/rr
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
��/
s
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
�J
Utility Notice (Perm)/O/
Opt,�,��,
P O BOX 1504
Building��
Address
Owner
/ 78-495 CALLE TAMPICO
i ASCO LA QUINTA, CALIFORNIA 92253
{t
Mailing `) l
Address
City ZipIT:t
Contractor
Address
Zip
State Lic. // I Glty
& Classif. ,� l '1 .� Lic. #
Arch., Engr., ;
Designer . ; l
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that Vern licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of/the Bu mess and Professions Code, and my license is in full force and
effect.
t r
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 (5500).
l: 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'1 I, as owner of the properly, 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.)
17 1 am exempt under Sec. ,B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
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 it the permit is for one hundred dollars ($100) valuation
or less.)
*I certify that in the performance of. thp 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
Ihereby affirm that there is a construction lending agency for the performance of the
work (or 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 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
e
APPLICATIO4y
LDING: TYPE'CONST, OCC. GRP..
.Number
al Description1'
ject Description S � I �
Sq ii Stories Ft. / �}
Size / / � Stories
New,0 Add ❑ Alter ❑
I
( M
NoDw.
Units
Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. -Z-I> 0---
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
0
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line t
a
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date It
Validated by:
Validation:
JAN1
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
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 2/14/01
No. 21657
owner NameContemporary Homes
No, 54-160 Street Avenida Velasco
APN #
Jurisdiction La Quinta
774-215-008
Permit # 0101-204
Log #
City La Quinta Zip 92253 Study Area
Tract # BLK281U26 Lot # 8 Square Footage 1421
Type of Development Single Family Residence
Comments
No. of Units 1
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
2.05 X 1,421 or $ 2,913.05 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 - Union Bank of California - Robert KelloggTeiep�one X760 -b4-1962
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exe ted by Annette Barlow
Signature
Payment Received $2,913.05
Check No. 7231944
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 96 -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 sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them an the District('s)(s') behalf, whichever is earlier.
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
O1%0; r'O1 11: 33 FAX 17608049062 COMiIiONWEALTH TITLE Z002
RECORDING REQUESTED BY;
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
william Thomas Buf fin..,
Power Brokers
P.O. Box -134
La Quinta, CA'92253
SPACE ABOVE THIS LINE FOR RECORDER'S USE
The undersigned grantor(s) declare(s);
Grant Deed A•P•N• 774-215-008-8
Documentary transfer tax is $ e conveyed, or
( X, computed on full value of property
( x) computed on full value less value of liens and encumbrances remaining at time of sale. and
( ) Unincorporated area; ( ) City of
FOR A VALUAEILE CONSIDERATION, receipt of which is hereby acknowledged,
MARGARET C. STONE, Successor Trustee of the Stone Family Trust
hereby GRANT(S) to. WILLIAM THOMAS. BUFFI'N, an unmarried man
the real property in the City La Quinta
of County of Riverside
. ,
State of California, described as
• Lot•• of Block Unit No. Santa Carmelita at Vale La'
Quinta, as . -per map recorded; in Book � _ pages- _5� fof Maps, Records of Riverside
County, California
Dated. Januar 9 2001 Signature of Grantor
Slate of California )
County of ) SS.
•Margaret C. Stone, Successor Trustee
On before me,
personally appeared
personally known to me (or proved to me on the basis of satisfactory _
evidence) to be the person(s) whose names) isiare subscribed to the -
within instrument and acknowledged to me that he/she/they executed
the same in his/her/their . authorized capacity(ies), and that by
hislherltheir signature(s) on the instnimerit the person(s), or the entity —
upon behalf of Which the person(s) acted, executed the instrument, '
WITNESS my hand and official seal. „
Signature
MAIL TAX STATEMENTS -T0,
. I
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, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please`attach additional explanations as"necessary.
APPLICANT CONTEMPORARY HOMES
SITE ADDRESS 54-160 Avenida Velasco,
APN 774 _ 215 - '008 BIN NO.: CASE NO.: 2001=389
LEGAL: LOT 8 BLOCK 281 UNIT S.C.@V.L.Q
CHECKED BY: Fred Baker DATE:
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 .
COMMENT/CORRECTION
Compatibility Review
1
Case logged and number assigned
Verify legal and APN information.
Consistent with MDG on file (as.applicable
AF
PR VED BY QMUNITY DEVELOPMENT DEPT
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
`
1.71
SE N0.
Other Requirements:
I i -'l i IVI�
�O YTIVIPIR f,.l Y9 q, q "', T. -I
TIPP "T J3V',l
APR 02 01 19:03 FR s., TO 9-5642534
��;
TInf dn,-'....
0"w"
0
BuildOn
Engineering 9 Consufflng Testing
REPORT OF FIELD COMPACTION TESTS
TESTED FOR,. CONTEMPORARY HOMES
. PO BOX 1041
LA QUINTA,, CA 92253
PROJE&:-4 Til 6 0:.KV-k7-:qEASCO
.LA QUXNTA
DATE: March 12, 2001 OUR REPORT NO,: 073-10078-2
TEST DATA: (1) medium to coarse grained,,silty sand.' MOIST. = 9.076
TEST
NO,
2
3
4
P.01/01
MAXIMUM
ENT
COMM
Spec.
TEST, SOIL IOR LAB DRY AT E I; WET PERCENT 90% Min
OEPTMDENSITY TENT I
ELE Y!qt4 NUMBE CON DENSITY COMPACTION
. ..... ELEVATION__
8" FG i 126.0 6.5 130.4 122.4 97.1 1 A
129-7 121.6 96.5 11 A
all FG 1 126.0 6.7
FIG 1 i 126.0 6.1 131.61 124.0 1 98.4 !1 A
- --------------
ell 12 S. 4
FIG 1 126 12.1 114.5 90.9 11 A
A.
T
TEST LOCATION: Building pad.
I.NE corner.
SE; corner .
3 NW corner.
4 i SW corner.
NOTES: TESTS PERFORMED PER ASTM D2922-96 & ASTM D3017-96 *COMMENTS; 1. FILL MATERIAC A. TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES -SHOWN: Lbs. ercubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT COMPLY
WAT' �%C CONTENT: Percent of dry weight 3. BASE COURSE I WITH SPECIFICATIONS
TO
PERC COMPACTION: Based on maxlmurn dry 4.suEsASF C. RETEST OF PREVIOUS TEST
denso(obtal.ned on sample indicated by 5. SOIL CEMENT E.
MOIJTURF IN EXCESS OF IFICATIONS
mo I, G.OTHER
soil I nu
(1) ASTM D-1557, Procedure A E. MOI TUR DELOWSPECIF1 ONS
TEST INSTRUMENT: STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement. ADJUSTMENT M'
TECHNICIAN: Vinnie De Souza
Respectfully submitted,
Professional Service Industries, Inc.
THESF. TEST RESULTS APPLY ONLY TO TNF SPeCEFIC LOCATIONS NOTED AND Moky NOT RFP1tE4FNT ANY OTHER LOCATIONS OR ELEVATIONS.
REPORTS MAY NOT BE REPRODUCED, EXCEPT IN FULL. WITHOUT MITTEN PERIOSSICIN BY PROFESSIONAL SERVICE INDUSTRIES. INC.
'Professional Service Industries, Inc. - 42-240 Green Way, Suite C - Palm Desert, CA9221 1 - Phone 760/341-5790 - Fax 760/341-5794
PSI A- 1010-2 (4)f I
I I . ** TOTAL 1-HUL.01 **
I
City of La''Quinta
Building and Safety.Department
r
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: 54-160 AVENIDA VELASCO
Use Classification: SFD Bldg. Permit No.: 0101-204
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building: CONTEMPORARY HOMES Address: 51-370 AVENIDA BERMUDAS
City: LA QUINTA, CA 92253
+ _ By: STEVE TRAXEL
ldj"'L Date: 09-13-01
Building Official
POST IN A CONSPICUOUS PLACE