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0310-341 (SFD)LICENSED CONTRACTOR DECLARATION.' ftereby 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.:Datdi r 781834 B rMC, 1/21%' D"ateA,��'�eQ Signature of Contractor �' r 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. ( ) 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 STAT F.I•'UND Policy No. 173378s-03 (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 to the workers' compensation laws of California, and agree that"if I should become subject to the workers' compensation prov'is'io �pf,.S c ion 3700 of the Labor Code, I shall forjhwith comply with those:provl�fo• /Date: Applicant Z"_/ r + �r WarnFailure to secure 6r ers - ompensation 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 rsuant to any permit issued as a result of this applicaton agrees to, & shall, Inde & hold harmless the City of La Quinta, its officers, agents and emploting 2. Any permit issued as a result of this application becomes null and v work is not commenced within 180 days from date of issuance of permit,.or cessation of work for 180 days will subject permit to cancella I certify that I have read this application and state that the above informati correct. I agree to comply with all City, and State laws relating to the bui construction, and hereby authorize representatives -of this City to enter f the above-mentioned property for�inspection.-purposes. Signature (Owner/Agent)`De , t BUILDING PERMIT PERMIT# 031, 0- N. � DATE_ _ _ � ,VALUATION _ LOT— � - :�— —^---_TRACT.-- --_ —_—' JOB SITE ADDRESS I 5 Ct I;Lg Jhk APN 770-4&5-023 OWNER CONTRACTOR / DESIGNER / EN &NEER POV,T12119fi2TCE ASSOC I BRAUCICMANN 190, P,0, BOX 134 PO BOX S 17 IAG UR4T.A C�A 92253 LkQU71T.r.A. CA 922.53 Q60)409.5422 ORLN a �7 USE OF PERMIT SIMULE VAMUZ DW..1�.,I 1 wo 1514 Sr. SFID PERMIT DOES NOT I41C1,1JD 11L0CK 'WA1_4, POIDUSPA OR DRIVEWAY JPPROACH TRL. CT COHST11UCT10�1 1,514.00 SSI'' PORCWPATIC I 1176.00 SP GAR:ft.L}UCARPOWr $36,00 O1' UTD"11 f°O xOff' C;631V�iI1 iTCfl9O.l� !� t #f.1 .i PhIM10 ' 17# a SETALWARY CONSTRUCTION FEE . 101.000_418-©00 $621.30 . PLAN CHYCK FEE 101-000439-318 $516.55 'IEE DEPOSIT 101-000.439.318-"s2so.00 MECHANICAL FRE 101-000-421-000 E11CTRICAL FREE 101 TOOO.420.000 $112;21 PLUM811415 101-000 419 000 $126.00 , STRONO MOTION IME - RUID 101-00.0-241-000 19,51 izl3d'iI:1INOFE Y0i-0Q{D-d`,? -0t?fi VI3.00 DZVE1.0PER IMPACT FEE E2,�fl5,00 PRECISE ILC kN 101-OOU-�l�i y-34� �tOQ>DU Lr J lJ :LESS FREE,,1A [D MZ 4250.00 T(YrAL P1&�'.r FXX8 UZ N0W NOV 10 2003 CITlr OF LA QUINTA FINANCh DEPT. V RECEIPT DATE / 3 BY �� DA E FINALED�� INSPECT0 t INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Q Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck , cel Exhaust Fans O.K. to Wrap — F.A.U. Framing L Compressor Insulation _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall insulation Condensate Lines Party Wall Firewall Exterior Lath Drfmll - 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 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 Connection5, .;,Encapsulation Gas Piping - Gas Test i (/ Appliances - Final =MMENTS: -.w Final Utility Notice (Gas) L 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) 17 Date 11/10/03 No. 25180 Owner Power Finance Assoc. Address P. O. Box 1234 City La Quinta Zip 92253 Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units Q BERMUDA DUNES V) RANCHO MIRAGE (� INDIAN WELLS PALM DESERT ,y LA QUINTA �INDIO L� 770165023 La Quinta 0310-341 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 51945 Calle Jacumba 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 C/C-Valley Indepedent, Mike Brauckmann Check No. 297864 Name on the check Telephone 485-9269 Funding Residential By Dr. Doris Wilson Superintendent Fee collected Signature a Barbuzza Payment Recd $3,239.96 $o.00 Over/Under NOTICE: Pursuant to Government Code Section 69'020(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 'r . Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting iERbING REQUESTED BY: Orange Coast Title Company AND WHEN RECORDED MAIL TO: Michelle Elchstedt CIO Power Brokers PO Box 134 La Quinta, CA 92263 Order No.: R-2707484 Escrow No.: 9W92.RS A.P.N::'77t> 169-023 S j s t -�r�s " d"�-- DOC " 2003-130328 9V2S/2ee3 ea:eaA Fee:tO.N PaaIof2 li Deo T Tic Oald Reoerdad In offletej Reeet+ds County of Rlva"Ide a" L. Oros Assaaeor, Cetirnty Clerk A Reoordor, I1111111111 GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) DOUMENTARY TRANSFER TAX IS $55.00 [ X ] computed on full value of property conveyed, or [ ] computed on full value less value of liens or encumbrances remaining at time of sale. [ ] unincorporated area [ X ] City of La Quints FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, T. Swift LOGkard, Trustee and Blanche 0..Lockard, Trustee of The Lockard Family Trust Dated March 21, 1,991 hereby GRANT(S) to WILLIAM THOMAS BUFFIN. A MARRIED MAN AS HIS SOLE AND SEPARATE PROPERTY AND POWER FINANCE ASSOCIATES, INC., A CALIFORNIA CORPORATION the following described real property in the County of Riverside. State of California x42 of Block 3 -'of Desert Club Tract, Unit No. 2, in the City of La Quints, County of Riverside, State of California, as per map recorded in Book 20, Pagi(s) 6 of Miscellaneous Maps, in the office of the County Recorder of said County. Dated: January 30, 2003 STATE OF CALIF RNIA COUNTY OF jih-VAXI A On c/ 3 210before me 4 a Notary Public in for s id County acrd Sts e. personally aplS/.�. ..,/rm&n L— (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) Were subscribed to the within Instrument and acknowledged to me that heisheAhey executed the same in hlslherAheir autlrortzed capadty(les) and that by hisTheHtheir signatures) on the instrument the person(s), or the entity upon behalf of which the person(s), acted. executed the instrument WITNESS m and a offici. z al Be Signature Sig re of Notaryv MAIL TAX STATEMENTS AS DIRECTI=D ABOVE is area for offlclal notary seat) The Family Trust Dated March 21, 1991 r� By. T. Swigard. Trustee `9lanche G. Lockard rustee :IOGNE1f SL/►GLJ: Ions1325057 Z ,�, Pursue. eetiienda is River+dde County pyCearn6Odt19�� Certificate -of Occupancy.C City of La Quinta Building and Safety Department OFTM " 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: 51-495 CALLE JACUMBA Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: -310-341 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: POWER FINANCE ASSOC. Building Official Address: BOX 134 City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: 4/30/04 POST IN A CONSPICUOUS PLACE -µin