0306-050 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date t
Da_ V
te_ 1 -::T Signature of Contractor �' „�•� ���'^ ��
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
•
( ) 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.
w( •) 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:
Carr,ier ''tb,F1113'�J Policy No. i• GiQ'7'•wilt)
(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 those provisions.
/)ate:"! �T �1 Applicant— /9-1 ."%n 141.4"", , max%.
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.
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-mentioned property'forinspection,"purposes.
.Signature (Owner/Agent) V¢� Date` °r }
BUILDING PERMIT PERMIT#
�►al
DATE ,,_, VALUATION LOT TRACT
�!..' <a — 1.13:•, ,10 '� . W?UK5
JOB SITE.y �j ` pT
ADDRESS 45j<^o%,(. N1+
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
`rHCAAS BfFFM
3A�M'di,ADTWWOF
.P,00t)34
'1^J90, DIR. .
I.A QUIRTA CA. 92253
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C%Ui 3724
USE OF PERMIT
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'LE,SIB P;R:8,PAV,).sn— r
4250.00
JUL 0 2 2003
CITY OF LA QUINTA
FIIYANC oPP1r
RECEIPT
DATE
• t
r
BY \ yr^`
D FINAL
_ GG
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
— O
Underground Ducts
Forms & Footings
14Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
/
F.A.U.
Framing
a2
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
Final - G _
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 Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-
_
Final'
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole _ 3
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)
CERTIFICATE OF COMPLIANCE � FIEDS
Desert Sands Unified School District �o�c����
47950 Dune Palms Road o
Q BERMUDA DUNES lam'
Date 7/1/03 La Quinta, CA 92253 (/) RANCHOMIRAGE C:
No. 24645 (760) 771-8515 �� INDIAN WELLS �.
PALM DESERTLA ,y
• IND OT`^�
Owner
Thomas Buffin
APN #
770-163-019
Address
P. O. Box 134
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0306-050
Tract #
BLK 5
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 7
51375 Calle Hueneme 1918
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 1,918 S.F. or $4,104.52 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 CC/Valley Independent Bank - David Addington Check No. 287295
Name on the check Telephone 760/408.7528
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected
Signature
IvrPv
$4,104.52
Payment Recd Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - ApplicanUReceipt Copy - Accounting
3
FEB -05-2004 04:52 PM �+
CERTIFICATE OF FIELD VERT
Project Title
Pro)' tt A ress
. fizue
Builder Cont t
HER5$ater
O,
TESTING
Plan Number
Sample Group Number
�r(Ifying Signature �p� Sample House Number
Firm: rC. 1p s'&lGi!�PS HERS Provider. �G.� �iS�cG/�%�
Street Address' �S��d ,b'rw� DY� C„r�l� CitylState2ip: Z4
Copes to: Builder, HERS Provider
HERS RAIER C P E §Jj&19MW
The house was: 10 Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providin diagnostic testing and field verification, I certify that the houses identified on this form
com with the diagnostic ested compliance requirements as checked on this form.
Distribution system is fully'ducted (i.e., does not use building cavities as plenums or platform returns In lieu
P-01
CF -4R
ducts)
Where cloth backed, rubber adhesive duct tape Is installed, mastic and drawbands are used In combination
with cloth backed, rubber adhesive duct taps to seal leaks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Measured
Duct Pressurization Test Results (CFM ® 25 Pa) values
Test Leakage Flow In CFM
If fan flow Is calculated as 400cfmlton x number of tons enter
calculated value here
If fan now is measured enter measured value here ����
Leakage Percentage (100 x Test Leakage/Fan Flow) =. 7► a
Check Sox for Pass or Fail (Pass=6% or less) w ❑
Pass Fall
THERMOSTATIC EXPANSION VALVE TXV or Commission a2proved equivalent
Yes Q No Thermostatic Expansion Valve (or Con=ission approved
equivalent) is Installed and Access Is provided for Inspection❑
Yes Is a pass
ass Fail
�] MINIMUM REQUIREMENTS FQR DUCT DESIGN COMPLIANCE CREDIT
1. 0 Yes 0 No ACCA Manual D Design requirements have been met
(rater has verified that actual Installation matches values in
CF -1 R and design on plan.
2. Q Yes C7 No TXV is installed or Fan flow has been verifled. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
O ❑
Yes for both 1 and 2 Is a Pass
Pass Fail
.. .,<....._...... _,e.....,.,.e ,. ...... .._.... ....-.moo. ..... ..... ....«.. .. ,. »..,,... .. ..._. .... _....
Certificate of Occupancy.
W
INcaaroaehn
. i9M
G OF9 Building & Safety Department
This Certificate is. issued pursuant to the requirements of Section 109 of the California Building
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: 51-375 CALLE HUENEME
Use classification: SFD Building Permit No.: 0306-050
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RM
Owner of Building: T. BOFFIN Address: P.O. BOX 134
City, ST, ZIP: LA QUINTA CA
By: KIRK KIRKLAND
Date: 2-6-04
f
Building Officia
t
POST IN A CONSPICUOUS PLACE