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0304-272 (SFD)LICENSED CONTRACTOR DECLARATION �. U) I hereby affirm under penalty oVperjury that I am licensed under provisions of H Chaptar9 (commencing with,$ection 7000) of Division 3 of the Business and 04 W Professionals'Code, and my License is in full force and effect. O� M License # - Lic. Class Exp. Date t` to wr- ;i6$290I B )VO /2( Z r� -Date`C ,''1 ) Signature of Contractor (gyp o' M f / G< 3 t _ i't 4_1\ l_'✓ t,.-._ J- U �f OWNER -BUILDER DECLARATION Ha I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for`the following reason: Z_ A ) 1; 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.&,Profes ionals Code). Iiii' t i;//1�r lIAtI (.) I, astownejJLof the propert , am exclusively Contracting, with licensed "contractors t6,dbnstru6tCth6' p0bject (Sec: 7044, Business &,'Professionals Code). / .� l • .�(• `✓ I am exempUunder`Sectionr B&P.C. for this reason Date . h J. l/;i �`Sign'atar'--/of Owner v v WORKER'S COMPENSATION DECLARATION ,�'< I.hereby afflifmnder�pa�ferjury one of the following declarations: O I have�fw�ll rriamta�ir� a ftificate of consent to self -insure for workers' compensat�on,'%as^p�wf foyP9 Section 3700 of the Labor•;Code, for the performance of the worK for w/ bj h 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: CarrierPolicy No. ` s+rA�.1z : ri 229: 0610797-20011 (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,' m I shall not employ any person in any manner so as to becoe subject to the workers' compensation laws of California, and `agree that if'•l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,;1 shall forthwith comply with those provisions. Date r: _,11 • Applicant _t .13 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. r i 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 & eac:6 person at whose request and for whose benefit work is performed under-orppursuant-t, any permit issued as a result of this applicaton agrees to, & shall!"indemnify, i & hold harmless the City of La Quinta, its officers, agents and eimp�loyees7— 2. Any permit issued as a result of this application becomes null'a`ndtvoid if work is not commenced within 180 days from date..of issuance` of such�r+A permit, or cessation of work for 180 days will subject';permit to cancellation. u � 1 I certify that I have read this application and state that the above information-ist:, correct. I agree to.comply with all City, and State laws relating to the building f1 `construction, and hereby authorize -representatives of this City to enter -upon -- the above-mentioned`property for inspection purposes., 'Signature (Owner/Agent) f '• ✓- a r'- f .f ' Date � '- PERMIT # = BUILDIN:G PERMIT DATE''T `- ' VALUATION . LOT , .' + TRACT' - 3: 1 I� D.IL, d , 7 r j `,•. ,�� � 11�j'� ;. % rc . "_ i -60- T '' 4 JOB SITE ADDRESS XVK rir 77. i �o 2 OWNER - CONTRACTOR/ DESIGNER Z,ENO INEER 1740MAB BM704,, :. I. 1 tAt31JI d TO�d PA P(Yk-134 al�� 41-80 km"a3!?i1�:�Atas R, LA Q INTA C A 92 3 ' 'B 1FIna lO'IIA12r+�`4. CA 92201 i i?6th t3 W�5x i (ML4 .724 USE OF PERMIT 1 i 1478 S.P. St a• PZP.M1T V695,'HOV MIC 1,1 �pl B1DC'IC �f AUL POOL OIt DR.11f1"WAY,APPR0A.0 qg 60-0s CT19N 1j4 OAF P��.C:I•III�If,Tt�i� 54.13' s1� GA:WEICAUORT r smATE D �;o T Or (:C?1;+25'fi.�'dCr`3�lX3N j 9E.:3- F(D � pmaw.fi CONSTRUCTION FEE , � 101.000.418- 00 PLAA14 CH11MIC ME -1,04-000-439�318 � ' . $501,79 'Ii' R D&POSIT 6 101.030.439.318 4150,00 A/ECHAR1ICALM '103-10110-421-060 ; - ( $5.2.50 I.LI';G CAt, FEE 141.OQ0 420.000 PLUMBING Mt 9 C►2-t�s"'U-r1 a+�-f10U $118.0(3. . ;STRONG MOTION FU . RID -1.01.000=2.41.000 c1Rr�.1�l�acs Ir13t'�, . • >." • _ :t. 1(31=130* -x,23-CaQfi $15.00 • r, ' - D9V. LOOP IMPACT FkZ .101-060�441-345. . P11=18E PLAN $100.00 ' - , TAL t':(Ylt '3 yTiO2v` AAS? FLAN CERWK UZI; PPE -PAM r r 4250,00 2 3 203 IWAL PT"N E+-ff k-'-T'Et x)VILK NO'1 :} 1 FL.AQUIWIA � IAHCE OEPT. 'RECEIPT DATE BYDATE F.INALED INSPECTOR �n L 4,: 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 Exhaust Fans O.K. 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 _ nruviall _ Int I ath Final BLOCKWALL APPROVALS Set Backs Final Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Piba. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster . Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Pipina Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Q Underaround Conduit Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power 7 / POOLS - SPAS T4 thytl 4 u�cv P.O. BOX 1504 Building L. _ fU 78-495 CALLE TAMPICO Address /y L LA QUINTA, CALIFORNIA 92253 Owner .� ICS 0,01F/ / A-' Mailing n Address Av, /J t7 [3,q c p 7 Cit Zip /7 0C., / 4�� Tel, V� '0 y! 6 Contractor ress `7 / 7,F0 hW�tM - n 2Al-A71-09,41 /7,.Vi Zip G'/)) O/ 1 T61. L/ Z DOQ` 2&ZIr State Lic./p City & Classif. V (J a G� / Lic. # Arch., Engr., t� / Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that I 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 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 fo'fts 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 thealleged 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). 17: 1, 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.) IA 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 contractors) 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 (l Copy is filed with the city. ❑ 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 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., 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 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.) Lender's Name Lender's Address This is abuilding 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 WHITE = BUILDING DEPARTMENT a 36 Al -Alk APPLICATION ONLY BUILDING: TYPE"CONST. OCC. GRP. A.P. Number 3 — -- 2 Legal Description tQr3 � o Project Description " �r Sq. Ft. /' No. No. Dw. Size ' i Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Estimated Valuation ' PERMIT AMOUNT Plan Chk. Dep. Date Permit Plan Chk. Bal. Const. Validation: Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure " QUINTA Pr. 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: YELLOW = APPLICANT PINK = FINANCE CERTIFICATE OF COMPLIANCE _6Ft�sc Desert Sands Unified School District 4��0 47950 Dune Palms Road z x o La Quints CA 92253 ¢ BERMUDA DUNES r Date 5/22/03 RANCHO MIRAGE CJ Quinta, � INDIAN WELLS ti No. 24453 (760) 771-8515 PALM DESERT yINDIO ` Owner Thomas Buffin APN # " .. c 773-172-012. cls Address P. O. Box 134, Jurisdiction La Quinta , City La Quinta Zip 92253 Permit # 0304-272 Tract # BLK 60 Study Area Type Single Family Residence No. of Units . 1 Lot # No. ' Street S.F. Lot # No. Street S.F. Unit 1 13 51980 Avenida Vallejo, 1478` 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'additioris under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleepingi 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 ' a w Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $2.14 X 1,478 1 S.R. or $3,162.92 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 - David Addington _ check No. 287199 - Name on the check Telephone 760/408-7528 4- Funding Residential By Dr. Doris Wilson ., Superintendent ° Fee collected /exempted by. Sharon cGilvre, $3,16.2.92 Payment Recd 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 - Applicant/Receipf Copy - Accounting t ' DEC -11-200.3 07.:24 AM 13.02 CERTIIiICATEW FIELD VERIIF'ICATION AND DIAGNOSTIC TESTING C: 1�-41:2 Yes E `No Thermostatic Expansion Valve'(or Commission approved - 4Proie�t Ti Date y� equivalent) is Installed and Access is provided for Inspection Projgct Address Builder Name . ❑ MINIMUM, St ilde pnt' t. Telephone Plan Number P039� f=all' 1. Q Yes' HERS nater •;.-1e1epnone' Sample Group Number' 4 rr Cor ying Signature t7 .'Sample House Number i Firm; HEFTS Provider: TG ,� ,ef ii scree% Aaaress; za.40 4 0K,,1 l &[e CltylStatelZlp: Z W r � Copes to; Builder, HERS Provider HERS_ RATER COMCklAhlgg STATEMEN yy The house was; I@ Tested +a Q Approved as part of sample testing, but was' not tested-., 2 yes As the HERS rater providing diagnostic testing and field verlflcetlon, l certify that the houses identified on this form comply with the diagnostic tested compliance requirements as checked on this form; Distribution' system is fully ducted (!,a,, does not use building cavities as plenums or platform returns. in lieu dof,ducts) ' Where cloth,backed, rubber adhesive duct tape.ls Installed, mastic and drawbands are used in comWnatlon with cloth backed, rubber adhesive'duct tape to'seal leaks at duct connections_jK ; s MINIMUM REQUIREMENTS FOR.DUCT L-EAKAGE RED.UC710N COMPLIANCE CREDIT Measured Fan Flow—_,.- Duct Diagnostic leakage Testing Results (Maxlmum 8% Duct Leakage) Measured Duct Pressurization Test Results (.CFM (x'25 ft),, values -for. both 1 and 2 is a•Pass • ' � Test Leakage Flow In CFM I' If fan flow, is calculated as 400cfrnhon x number of tons enter { + calculated .value here ;I .:. : .' if fan flow is measured enter measured value here ' E Leakage Percentage (100 x. Test Leakage/Fan Flow);- low) =Check CheckBox for Pass or Fail (Pass:=6% or less) . ] - } 7 THERMOSTATIC ruivalent Pass. Favi EXPANS16N VALVE TXV or Commission approved. a Yes E `No Thermostatic Expansion Valve'(or Commission approved - equivalent) is Installed and Access is provided for Inspection ❑ MINIMUM, Yes is 8 ass �; P � REQUIREMENTS FOR DUCT DESIGN COM PLIANCE.CREDIT P039� f=all' 1. Q Yes' 0 No ACCA Manual D'Design require meve been met rr (rater has verified that,actual Installation matches values in CF•1 R and design on plat), yy 2 yes b No, TXV is Installed or Fan flow tial boon verified. If no TXV,. �%�• - ' verified fan flow matches design from CF,4R, s Measured Fan Flow—_,.- -for. both 1 and 2 is a•Pass Pass F�• i. : l Ali 1, ij p®� � 1L.,a A � ,*. ax,.w r �c 4 d ..^sw•'f+M.nw k w. � w Wrrt� -- 4�:>? .[ w{.x«+ . ••r»..3 ',$-✓`:.4Fv'v't'�'1�M3 a-",.. ,Z,.?,rry<p». 'e.:aaw .. .qp T.'3 fi � OcCertificate O*fc O� y� � R M • ✓Y F �: t OFT Building & Safety Department to the Section 109 of the California Building This Certificate is issued pursuant requirements of 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: 51-9W"ENIDA VALLEJO . t � Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-272 4 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC M ME ! a Owner of Building: THOMAS BUFFIN - Address; P.O. BOX 134 I ; City, ST, ZIP: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: December 15. 2003 i Y' Building Official POST IN A CONSPICUOUS PLACE U10.uw+'... .+.5 th-- +f'�ti •'i'ii.�L '.t6vd•'¢'. .. ,..3 .a� A -ik Nt A•- 4 ask"_ 3i?„r?w'