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0007-123 (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 " PfSssionals Code, and my License is in full force and effect. License# Lic. Class Ex !Date Date t'"-� 'Iignature of Contractor ! 1 - t OWNER -BUILDER DECLARATION � I hereby affirm under penalty of perjury that I am exempt from the Cont actor's 1. License Law for the following reason: f/ ( ) 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. ( ) 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 STATE FUND Policy No. 92999 -009671 - (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 hat if I should become subject to the workers' compensation provisions o fiction 3700 of the Labor Code„Iashall.fo hwith comply withrtho'se�provisrons Date:` -n %1'c�+APPlicant Warning: Failure to secure Workers' Compensation cov cue is unlawful and shall subject an employer to criminal penalties and civ'I�ftnaes up to $100,000, im addition to the cost of comp'e'nsation, damages as provided for in Section 3706A, 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. k:s 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. t I certify that I have read this application and state that the above information is correct. I agree to comply with all City,and Stat?/laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned prop r y r ipspect�lpurposes''r t� Signature (Owner/Agent)' + Date _. BUILDING PERMIT PERMIT# DATE /r, p VALUATION LOT 0007"M TRACT l/d/ ,::3 .10 3 lei :3 U2 JOB SITE ADDRESS .59.-31.5 CAI &F. aiACUAID'1, APN 770-165.011,41 OWNER CONTRACTOR/DE IGNER/ EN (NEER �+y�7�y�p �y t�yy� +y y�,y ' 3'AOJiY AS F.76i�i'L�V T q�,ygy Z�7+ exp �y a ,.°. DEL EI V ; S 78-080 CALL -F3 IFWAOO, 50111E 204 LA QU T?'A CA 92233 (760)564.1666 CB140 $59 USE OFPERMIT � 47J.L9 VdnL:. J.'.#'97,VJ�r� J� YYJil.�LI1Q l7 � . SFD - 5.1 (98) cM1'NTER PLAN . PEI:kIff DOl.'.5 NOT INCLUDE BLOCK WALL OR POOLr TRACT C014STRUCTION 1,421,60 5F PORC1HIPATIO 36.00 SF 0ARAGE!CARPORT (SF) 9,996.00 5 IrT. WOOD MCM 300.00 Lir yy�,� A�� �+�yy� �1 �vp (� �y[gnf�py+�-��y��+y(�(l9�y .A.�SMA[�1'.M cos OF l:.i.�NS11 i.V4�+.fi.+J.7 P7,.s�u7r7ad� CONSTRUCTION IFEF, 101.000.418.000 094.50 PLAN CHECK FEE 101.000-439-318 $300.12 MECHANICAL FEE 101.000.421.000 $40.00 RLNa(<TRICAL. 101£E 101-000-420-000 $139.44 PLUMBING FEE 101.000.419.000 $110.75 STRONG MOTION FEE - RTI SID 101 -000 -;VII -000 $8.43 Oi'ADINO FEE 101-000=4V-000 $28.00 0_T1VTJ,.0PZR IMPACT PEE $1,907.00 PR EC YSE PLAN 101.000441-345 6100,00 $'1?E DEPOSIT 101-000.4319-318 -$250.00 3 -TOTAL COAI`8'TRITC1ON AND PLAN C:N1 = $3,430.74 LENS PIW-PAID Ffi"E, 4250.$50 T(YrAL PER I+'.G'".ES DXT9 NOW $31-180274 t . RECEIPT DATE BY DAT F N D D INSPECTOR 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 Drywall - Int. Lath ��� _ Final BLOCK WALL APPROVALS Final 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 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 _ �PAa'I� 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) COMMENTS: 4 P.O. BOX 1504 Building S f I�C�,c��, �7895CALLETAMPICO Address 1 �' j U1 QU NiA, CALIFORNIA 92253-- Owner 2253Owner Mailing Address �• ,,, Address --� Zip. Tel. /� / , Com, • %2iCG E, State Lic. �. City & Classif. � , S Lic. # ngr., ZipState 1:�Z-2 LICENSED CONTRACTOR'S DECLARATION 1 that I am licef(Sed tinder omvisions of Chanter A Icnmmnnninn wltrLfi,.n is. in fuArtorce and I hereby affirm thatfl1,am exempt from the Contractor's LicensKaw foi the following reason: /Sec. 7031.5, Bu°slness and Professions Code: Any city o county which requires a Permit to construct, alt' improve, demolish, or repair any struct e, pdor to'fts issuance also requires the applicant /or such permit to file a signed stateme that he is licensed pursuant to the provisions of 1he�Cons for's License Law, Chapter 9 ( mmencing with Section 7000) of Division 3 of the Business antl Professions Code, or that. h is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7 1.5 by 'any applicant for a permit subjects the applic�'nf fo a civil penally of not more than fiv hundred dollars ($500). I.: I, as owner o the property, or my employees_ wit 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'I 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 7 1 am exempt under Sec. B. 8 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 r7 Copy is filed with the city. ❑ 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 ($100) valuation or less.) I certify that in the performance of thq 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 A 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 -of this city to enter the above mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Z� APPLIC TI N ONLY PISS .. DING: TYPE'CONST. OCAC. GRP. Number -77,-_--).A T. 6)/T` I Description L 0 7--3 1 )�&_, f�, U ()f -T/ i Ict Description . lk !t 'S i 4 f -U wf C 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 FIN INSPECTOR Issue by: Date Permit Vabt 8 . Yiep, A QUIN 1r, WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Ft. 1 j Size No. i No. Dw. Stories Units New [ Add ❑ Allt�er ❑ Repair ❑ Demolition ❑ ,q AR Estimated Valuation PERMIT PAMOUNT 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 FIN INSPECTOR Issue by: Date Permit Vabt 8 . Yiep, A QUIN 1r, 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 r- Date 8/4/00 1 No. 20843 Owner NameThomas Buffin a CERTIFICATE OF COMPLIANCE No. 51-315 Street Calle Jacumba City La Quinta Tract # Lot # APN # 770-165-014 Jurisdiction La Quinta zip 92253 Permit # 0007-123 Log # Study Area Square Footage 1421 Type of Development Single Family Residence No. of Units 1 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 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 B CC / Valle Independent Bank - A. P. Lench By Y P Telephone: 764;564=1866 '- Name on the check By Dr. Doris Wilson Superintendent - Fee collected /exempted by Annette Barlow Signature Payment Received .$2,913.05 Check No. 227221 40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified rbove 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 :ollect them on 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 JUN.16.20aQ 11143AI'I COMMONWEALTH RECOFZZRG REQUZA BYE CHxC. O T7CTU419 COMPANY COMPANY 10044KC 207096656 "K= RZOMM Mul, TJIaS DSSD AM, UNLEas OUN WISM SHOW BELOW, MAI& TAX STATEbams TOE MICHILLS SICHSTRDT NO. 320 SPACE P, 2/2 3p,ctmw, T9tYS,.L1't�"FQ1i R�CQRA�R° APLJ.ir 770,-265-014-1- The 70165-014-1 The undersigned ,grantor (s) declarae (e) : Documentary transfer taxis $19.93 (Xxx) Computed an.full value of pxoPerty conveyed, or ( ` CojppUted on full. -Value ISSM-liens aod,enCUmbrancee remaining at time of Pala, ( Unlncorporat04._Area: ( ) City of and POR A VALUA,BLS CoiTSIASRATIoN, receipt of whSch is hereby acknowledged, 67EROME ?. DABR.YSR, hereby GRANT(S) to WILLIAM THOMA.B BUFFIXg AN uNKXRRIED MM the real property in the r-Ity of'LA QurNTA, County of Riverside, State of California„ described as: Lot 3, Block 3, Unit No. .a „ Tract Dessrt Club, as per map recorded in Beck 6, Page(0) 20 inclusive of maps, in the oftiee.or tha County Recorder of said.County, bated dune 16, am state of Calitbrnia County of t s's. On before me, personally appeare4 peraonelly known to m® (or proved to me on the basis of Satisfactory evidence) to be the .person(e) whose name(a) Ware aubsCrybed to the within instrument and acknowledged to me th9t he/she/thFAy 'executed the same ' in his/her/their authorised aapacity(iea), and that by his/her/their signature(a) on the instrument the pargon(s), or the entity upon behalf of Vhich the p®reon(a) acted, executed the instrument, WXWESS my hand and official goal, Signature MAZZ, TAR 8TA+i+Blpd 9TS Top I/1 'd IL92,''0N .TEROME F. WERNSR Copy ERTI 0 T TO BE A T LE AND DCAOT Ay �� Commonwm� Alln L4nd TMa Eeorow (This area for official- zotariai seal) , L NCd9 83AOd Wdic- J.l 0006 1 C: P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 September 18, 2000 To: Whom it may concern 'RE. 51-31AL-LE �JACUMBA-� (760) 777-7000 (TDD) (760) 777-1227 Re: Assessment District 2000-1, Phase VI Improvements -Areas A, B, C & D The Property Owner: WILLIAM T. BUFFIN APN 770-165-014 is located within the City's current sewer assessment district. The City anticipates construction of sewer facilities within the referenced project limits beginning in mid to late October 2000 and expected to be completed in late May 2001. If you have any questions regarding the project please don't hesitate to contact me immediately at 777-7045. . Sincerely, Jo M. Freeland Senior Engineer • c: To Berg, B&A Project File 98-19A,B,C&D T.\PWDEFRPRO)EC711 SNcts\9819PhVNettas\CmricswrMmo.wpd I ASSESSOR'S PARCEL NUMBER COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY /% DEPARTMENT OF ENVIRONMENTAL HEALTH r r - PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM APPLICANT. Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list. A non-refundable filing fee is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this applica- tion shall remain valid fora period not to exceed one year from date of payment. LMS #( reS�'�i1.'.)/ //,-a, r- Agent,, Contractor, Contact Person Address City State Zip Telephone/i / Y _ Owner Address City State Zip Telephone Q �f /'/I' /� �-' 41,� - -�.1!1 / // Z Jdb Property dress City Zip U Lot Size Water Agency/Well/ Use of Permit, P/P, SUP, PUP, etc. Legal Description r L,",f 'Dwelling,,MH Site Prep., etc. Signature of,Aplicag!.,o Date r � CHECK BOX IF REQUIRED /` i ] (f If any box is checked, this application shall be considered rejected until ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) the information is provided and the fee paid. Resubmittals later than 90 days after,date noted below may requite repayment of fees. ❑ Staff Specialist Lot Inspection Required /, m LI Holding Tank Agreements Completed Thomas Bros. Page Grid Z 0 ❑Certification of Existing S.D. System Required ❑ Date Lot Inspection Completed: Initials U C3WQCB Clearance Required LU (Attach for DOH-SAN-007, Santa Ana Re ion Only) Y) Remarks: ❑ Maintenance Booklet Provided ❑ Soils Percolation Report Required ❑ Special Feasibility Boring Report Required ❑ Final Inspection by Department of Environmental Health is required. ❑ Rereview Required Initials Date Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring Report by Lic/Project # Date Soils Map Page Soil Type Approved By Date No of Systems T pe of System(s) No. Dwelling Units (1) Septic Tank Soil Rate Grease/Sand Holding Tank ❑ Replacement Bedrooms, Fixture Units Grease Intcp/Lint Trap / New ❑ Addition Existing , "-?-7,n 7. Gal. Z.`) 1 Gal. Sq. Ft. Total Linear Sidewall Allowance r Leach Bed sq. ft. of Bottom Area Ft. Bottom Area ft. rock/ sq. ft. running ft. Install Line(s) ft. long ft. wide with Inlet Tested Depth ❑ NA min. inches rock below drainlines or U Proposed Bottom Tested Depth Z Leach lines/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other: O Total Depth Allowable H Applicable Depth / LU N/A Overburden Factor ❑ 5' © IT / A) TD /y Well Review Approved: Date: Well Drilling Permit # SIGNATURE Grading Plan Approved: Date:SIGNATURE 11 Sewer Verification Approved: Date: ,, r i ,, , V h /{ • (, �' a v I Plan Check Only Approved: Date: ; v JA REMARKS: //A. r: ! +%t.[ .1.� Z-1 J''a /:�-//'i IYlnt /X �n/ "J, / n -- •i✓ 1iy n� )/S1i ./ Cr >i��/ �%t / (i. Ile ./ /` � it � i , • This application is APPROVED/DENIED for the category checked in SECTION B FOR OFFICE USE ONLY above, regarding the design of a subsurface disposal system as indicated on the I acompanied plot plan, using the requirements set forth in SECTION C above. A build- ing permit is necessary for the installation of the above-designed system. No con. Revenue code t f'- r Fee $ struction Is permitted In the required reserved 100% expansion area,// (1) Septic Tank must be 100' minimum from any wells. jj 4 El # 6 J (2) Leach lines must be 100' minimum from any wells, including expansion area. Date i�'Z-�a G Initial i t Z (3) Sewer lines must be 50' minimum from any wells. Q1L V l O (4) Seepage pits must be 150' minimum lom any wells, including expansion area. lj ]b ( W f `, it Signatufe of Health Official -. - r Date DEH -SAN -122 (Rev 9/98) UlstrlDUSlon: WHI I t—Uttice File; YELLUW—Applicant; PINK—Bldg. Dept.; GOLDENROL—Plans/Records COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY ASSESSOR'S PARCEL NUMBER DR DEPAr',TMENT OF ENVIRONMENTAL HEALTH %%d _ n RERf AIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM r shall LMS # Agent, Owner Submit this form with four copies of a SCALED plot plan (1-20 SCALE) drawn to County specifications as indicated on the attached check list. able filing fee is required when the application is submitted. Check must be made payable to the County of Riverside. Approval of this applica- ain valid for a period not to exceed one year from date of payment. Y of LA Qyt;V7,1,--A. P Lam( Contractor, ZO Job Propeny Address tU Lot Size star Agenc 81r. 1.1 r U) �U xt� nc�tC - - /J uL-�FRa2 C's Signature of Applicant( v�1t/' / ! wd *u e -/§'- ?-/74 e City State Zip Telephone 64 Oma. 6d <Z�- _ City / State Zip Telephone C�v ( QY rr� CAz C"� City Zip 64 PUP, etc. Legal Description14�f Cc (/6 �qry /T r.tKw A11: L07 - 3� aL ak1, Date CHECK BOX IF REQUIRED If any box is checked, this application shall be considered rejected until the information is provided and the fee paid. Resubmittals later than 90 days after date noted below may require repayment of fees. to ❑ Holding Tank Agreements Completed Z ❑ Certification of Existing S.D. System Required O U❑ WQCB Clearance Required rW (Attach for DOH -SAN -007, Santa Ana Region Only) ❑ Soils Percolation Report Required ❑ Special Feasibility Boring Report Required ❑ Rereview Required Initials Date ❑ Detailed Contour Plot Plans Required (1 to 5 foot interval) ❑ Staff Specialist Lot Inspection Required Thomas Bros. Page Grid ❑ Date Lot Inspection Completed: Initials Remarks: ❑ Maintenance Booklet Provided ❑ Final Inspection by Department of Environmental Health is required. Please call 24 hours PRIOR to inspection. C/42 / Soils Percolation Boring Report by Lic/Project # Date Soils Map Page 11 r19Soil Type S (1rA fA Approved By Date No of Systems T pe of System(s) No. Dwelling Units (r) M4�C• (1) Septic Tank Soil Rate Greaas�e/Sand Folding Tank ❑Replacement Bedrooms, F�dure.Wnits. Grease) c /Lint Trap New ❑Addition Z 164TRl / Existing 3 �� 006 Gal. Sq. Ft. Total Linear Sidewall Allowance Leach Bed sq. ft. of Boit m Area Ft. \ m Area rock/ sq. ft. running ft. Install Line%o,_ ft: long ft. wide with Inlet Tested Depth C3 NA min. inches ro elow drainlines or U Proposed Bottom Tested epth Z Leach li es/bed special design for slope: (3) Pit Diameter No. Pits Pit Below Inlet (BI) Seepage Pit Maximum Other - O Total Depth Allowable Applicable (/ Depth W N/A Overburden Factor Q.SA► ( 5 �O TD____L2 Well Review Approved: SIGNATUREDate: Well Drilling Permit # Grading Plan Approved: Date: s,GNATURE Sewer Verification Approved: Date: Plan Check REMARKS: This application 9s,AP�PROVE�DENtED•For the category ctaecked.i"BGT48N-B ,above-regardingeih esd ign of a subsurface disposal system as indicated on the acompanied plot plan, using the requirements set forth in SECTION C above. A build- ing permit is necessary for the installation of the above -designed system. No con. •atructionInpermltted In the required reserved 100% expansion area. `(� n i"' m Septic Tank must be from any wells.ti / q 6 WA �FA IWIW� (2) Leach lines must be 100' minimum from any wells, including expansion area. 0 0) Sewer lines must be 50' minimum from any wells. Z O4) Seepage pits must be 150' minimum from any wells, including expansion area. 0 d /0 m+� Fn0- 17L�Ef 1 ko/A /Mitif LU Signature of Health Official /, ` o/ Date (/t/4 FOR OFFICE USE ONLY —" Revenue code/,fir �� 3P� Fee $ a0/ • © 0 Q Check # � DateCE-17- 00 Initial DEH -SAN -122 (Rev 9/98) Distribution: WHITE—Office File; YELLOW—Applicant: PI t �.Z "Certificate of0ccupancy'' City of La Quinta � Building and Safety Department 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: SFD Occupancy Group: R3 51-315 CALLE JACUMBA Bldg. Permit No.: 0007-123 Type of Construction: VN Land Use Zone: RM Owner of Building: THOMAS BOFFIN 'Tom 111t—,ot/ Building Official Address: P.O. BOX 450 City: LA QUINTA, CA 92253 By: GREG FOX Date: 1-10-01 POST IN A CONSPICUOUS PLACE L1