0308-312 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I amlicensed 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
3
682901 12/31/2(
�'�..'
lat-� '� > Signature of Contractor✓% •°r'a^" "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.
fi,) 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:
CarrierSTATE-FUD Policy No. M oof ► i-2003
(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
Worlters' compensation laws of California, and agree that if I should become
Subject to the workers' compensation' -provisions of Section 3700 of the Labor
4ode, I shalJl forthwith comply with those provisions.
Date: �� // Ci % Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
.for "a% permit subject to the conditions and restrictions set forth on his
application. ;
1. Each person upon whose•behalf this application is made & each person at
whose request and for whose benefit work is performed under or,pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La. Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
f
I certify that I have read this application and state that the above information is
correct. I agree to comply withrall City, and State laws relating to the building
construction, and hereby authorize -representatives of this City to enter upon
the above-mentioned property` for inspdection purposes.
Signature (Owner/Agent) 1 l��-iti ."• Dated"
BUILDING PERMIT PERMIT /t
VALUATION LOT OY*-392 TRACT
DATE�..
.. ,
rQ "4,724.143 17
JOB SITE _+
ADDRESS 77420 CAIAX rrX=. "
APN
774-2142-022
OWNER
CONTRACTORDESIGNER / ENGINEER
+1��.`�Ol Bl�W
+/
D.aRi�%/7si:�' J1.. AD'1/D 1701
P+C1+.BOX 13
41,480MWTAGE DR
LA QLMTA. CA 92253
BFdIdl!,/IMRfi.7'eJ'Id' S CA 92201
(160)408.7528 C B1.:'/ 3724
i.
USE OF PERMIT
SINGLE FAAdi Y DWMIM4 �
1,514 S.K SFb PERMIT DOFS NOT h4CLUDE 81,000 WALL, POOXJsvf
OR ORIVEVIAY APPROACH
TRACT C;OV43TRUCTION 1,514.00 SE
PORCHMATIO 151.00 SP
0ARAWCARPORT 334,00 OF
EMM70) Cfl$'T OF CONST ICUON
94,7U.3.0
y
. IC" � Ii ►7 Lil,N.N.ri1AS.E.i.�
.
CONSTRUCTION FEE 101-000.418.000 $617.00
PLAN CHECK IEE 101-000-439-319 $516.33
rZZ DEPOSIT 101.000.4397318 4250.00
M1 2lAN1C.A1,. FEE. 102-tJOif-42'1-000 $52.30
ELECTRICAL FRO 101.000.420.000. $112.21
PLUMBING PELF 101-000.419:400 '� 13fi. tl0
3TROIdO MOTION FEE - RESM 101-000-241-000 $9.47
ORAAINDFEE fill-t2Ct0 23»000 $15.00
DEti'pO.C3 ER 1TAPAC9 FEE 52,r403,a0
PRE(---1SZ PL3iN 141-000-241-345 10tt.tlp
9UB-;Ta AL C.".(l3, S R.L MON SND PLAN C'l;;i)wM
$3,963,51
Ss PRE --PAM FRE's
-I O.00
SEP 16 2003 '
CITY -0 LA OUINTA
FINANCE DEPT.
RECEIPT
DATE
1 / =
41
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
it OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
(j
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
.B 3
Exhaust Fans
O.K to Wrap oLF.A.U.
Framing
Compressor
Insulation
, p 3 !_37
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
62 espe�
Drywall - Int. Lath
Final
Final O
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- p,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection7,
. o
Encapsulation
Gas Piping
Gas Test
Appliances
-
Final
Final
Utility Notice (Gas) i
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)
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 $2.14 X 1,514 S.F. or $3,239.96 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. 287441
Name on the check Telephone 760408-7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia Payment Recd - $0.00
$3,239.96 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 - ApplicantlReceipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
S_
Desert Sands Unified School District4�.,cs�IlRl�yo
a
47950 Dune Palms Road
¢BERMUDA DUNES r
Date
9/16/03..
La Quinta CA 92253
RANCHO MIRAGE CJ
INDIAN WELLS
No.
24977
(760) 771-8515
rye PALM DESERT y
LA QUINTA
�RINDtO
y� ,
Owner
Thomas Buffin
APN #
774-242-022
Address
P.O. Box 134
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0308-312
Tract #
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 12
77420 Calle Temecula 1514 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 $2.14 X 1,514 S.F. or $3,239.96 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. 287441
Name on the check Telephone 760408-7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia Payment Recd - $0.00
$3,239.96 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 - ApplicantlReceipt Copy - Accounting
uuu.-« ud(Iut.) 11:16
r
FATCO ESCROW DIVISION
RECORDING REQUEWMD 6Y
First AmerlCan Title Company
AND WHEN RECORDED MAIL TO;
William Thomas Buffln
C/o 51370 Avenida Bermudas, #1
La Quinta, CA 9?.Z.S3
-7�Vo 0a Tm E L'u Ll�
TEL:760 568 0656+++++++ P, 002
,
GRANT DEED
Aeevo 7hW uM nor Viers u,e oety
00! A MA' 74:242-021 and"7.94',A, No.
"""` T.RY
242=022-� File No,: RPD -10916:9 (Bi)
the UndeMMwd GYantol(s) Wdam(s): OOCOMENTARY TK4N5Fi3iTAX 3132.00;
[ ] oompumd on P�peny conveyed, OR die consideration or rd value of TAx Lo•s0;
'
C ] comP ted on the Cohdderatian or full value IM value of Hens and/or enc ummnm rafmining at tlme of Salk,
[ unlnmryonbad arae; I ) CIV or ti Qa%ta, end
E
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Wilbur A.
Spouse and Trustee of The Andrews Vast dated ]uly 2, 1986 Andrews, Surviving
hereby GRANTS to wilii+am Thomas Brim, a married man as his sale and separate property
the following described property In the • of La Quinta, County of Riverside, Stag of California;
SLOTS AND ,g1: -
SHOWN K�?.F UNIT NUMBER 26 SANTA CARMELITA AT VALE LA QUINTA, AS
N BY MAP O"'TLE ZN"BBT,�OObi 20, PAGE 50 THEREOF, RECORDS IN TME COUNTY
OFFICE OP SAib COUNTY, "UNINCORPORATED". RECORDER'S.
Dated:
WlburA. Andre'ws, Surviving Spouse and
Trustee of The Andrews Trust dated July 2,
1986
Wilbur A. Andres, Trustee
- —�` Mall Tax 5tafaments Tb: SAME AS ABOVE
a Z988'oN .,�_ NI�� - �_��+ wasa�i-1 �ooi .tz:;�lnr