0304-266 (SFD)V r 1 t
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
0000r
Date Signature of Contractor i
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.
(N/) 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 , Policy No.
�T.t'T,F;1�11iNYY 1 �93i d3
(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.1 should become
subject to the workers' compensation provisions of Section 3700 of the.Labor
Code, I shall forthwith comply with those provisions.
,A te: Applicant t,
,Y
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 representativtes of this City to enter upoh
tiIhe above-mentioned property for inspection purposes.
/Signature (Owner/Agent t�� Date r
,.�
4h1
BUILDING PERMIT PERMITrY
A
DATE - VALUATION LOT TRACT
$113",.10 8 - -131;K 5
JOB SITE
ADDRESS Ct.""�V,'J C;AT.rLy�.�,f.'�.6W.�.ea�+-9
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
THOMAS B1.3F'FTJ4.
(CORONET CO.iIS`i'RIKITION
Plop BOX 174
1.Ac QTJWA cps * 922- y
LA QLM4TA CA 922153
(601564.4604 CB110 2261
USE PERMIT
AOyF�
1.9]215.1:'. sympF:Itimu 17OF..S iJoT-3hfCt.LtDE rAL,aC3C.w,0.1,LS, Fool.. LAIR.
Dil till+ WAY APPROACH
TRt,CT M431'RUCTION 1,010.00 SF
PORCHIPATIO 19,00 'SP'
GARth TUCARPORT 48%00 8F
Z1,n-.7MATND,' C -OS. ' CII!' dYON54NUCTION
CONSTRUCT SOH FEE -L '101.0004IS-000 3ti.s3. i1
PLA14 CHSCK i+EZ 101'.000-439-388 �3t9.rf4
FEF DUO= 101.-000.4 9.318-�5t1,40
11,4'fiA HA WCAL IMM .10.1-000-421-000 39.at►
K=TA,ICAL VER 101.000-420.000 x10,13
I'U MBINOPEP, 101 -000-419-000 $.124.00
STROA1OMOTION FE,9 - RUED 101.000-241-000 $1 Os
'GRADING l 1.01-000-423.000 $13.110
DEVELOPER IMPACT FEE 1I�1t99,a0 .
Pkv! ,c,lSLplp.N 101-000-441-345 �'i00.UQ
OU13-TOTAL CONBMUV1'1T01q.A)Tb'kP;f.MT CEEM
$-1.,097.45
-5 '-7? f I �'
- 25+0.00
'AL NOW
1?X_RMT FIFES 01119
FD
0 5 203 .
CITY OF. LA QUINTA .
FINAr4r . r)F e
RECEIPT'
DATE,
BY
DATE INAL D
INSPE
INSPECTION RECORD
OPERATION j
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
_ L
Exhaust Fans
O.K to Wrap
LILr
F.A.U.
Framing
— Q
Compressor
Insulation
7— 0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2 y O
Drywall - Int. Lath
Final
Final —
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
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
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:
.. _
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 8/5/03 La Quinta, CA 92253
No. 24779 (760) 771-8515
Owner
Thomas Buffin
APN #
Address
P O Box 134
Jurisdiction
City
La Quinta Zip 92253
Permit #
Tract #
BLK 5
Study Area
Type
Single Family Residence
No. of Units
Lot #
Unit 1 8
Unit 2
Unit 3
Unit 4
Unit 5
Comments
No. Street S.F.
51405 Calle Hueneme 1918
Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Lot # No.
4�J�P1EDSc�o
BERMUDA DUNES
CO') RANCHO MIRAGE d
INDIAN WELLS
PALM DESERT ,y
LA QUINTA
�3Q INDIO yJ
O J
770-163-021
La Quinta
0304-266
1
Street
S.F.
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 - Ish Coronel Check No. 259126
Name on the check Telephone 760/564.4604
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempt b Shar cGilvre Payment Recd 00.00
$4,104.52 Over/Under
Signature G
NJ
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/Receipt Copy - Accounting
..........
"FIELD -ICM -0 PA.c
TiON"T
P�Ufl..�,REPOFIT- no.:
PROJECT:
.-.,,+YCLFAr GAUGE INFORMATIONANO
ALIBRATION
f.)AIL" STANDARD
COUNTS
CALISA.4TION NUM8ER.S
FROM SHEETS
I VAALATION. PERCENT,-/-
RCENT.
GAUGE AC)JUS. ENT
% VAJRIATI`N Rom
LAST USE
,G - UGE TYPE ISAMPSELL
<T76 -. L E
MOISTURE:
01-STURE:
---TM
.til bE
-.1 -1 .1 M
'.."'OOEL NO.:CENSE:
OF TEST.
I GENS rry:
I OENSITY:
OENSIT-Y:
UM IN)-QMIAA I IUN
SO I:- ID VISUAL CLASSIFICAT!ON OF SOIL I MAX. DRY DENSITY, PCF -
0 P T I ry) U.m MOISTURE.
com,;DAc-ri0N---- I IAOISTURE GENERAL LOCATION:
REQUIRENIcNTS. % REQUIREMENTS.
.,-ZST
I 7,EADINC i QUOTIENT/
SOIL.
TEST
ELEVATION
MOISTURE WET/ORY
-C
PERCENT
COMMENTS
pj 0.
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10 No
D E PTH, IN
OF TEST.
0 N T EN T, I DENSITY,
COMPACTION
C= -AAL
PCF
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TECHMCLAN'.
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Nil
,2 - 0A
COMPAC -nON PSICE)(TAGE,DOES NOT COMPLY WrM SPEC-.F)CA-nONS
3 - RA.S E .COURSE
C RE= OF PREVIOUS TEST
+--- - I
0 mOLsTunE !N E--CZS-S OF S?-,CjFkCATIONS
(
E- MOL-TL;PE - EIELow s,-.c)ncAnoNs
l r �� - I I I
C= -AAL
-4
TECHMCLAN'.
E;ukL
-Z;> IES RESULTS COMPLY WT'i'H SPE{:FIGtT10�
,2 - 0A
COMPAC -nON PSICE)(TAGE,DOES NOT COMPLY WrM SPEC-.F)CA-nONS
3 - RA.S E .COURSE
C RE= OF PREVIOUS TEST
- - SUBeA-lE
0 mOLsTunE !N E--CZS-S OF S?-,CjFkCATIONS
S - SOIL CEME.VY
E- MOL-TL;PE - EIELow s,-.c)ncAnoNs
Certificate of Occupancy
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:
51-405 CALLE HUENEME
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: THOMAS BUFFIN
Building Official
Bldg. Permit No.:
VN Land Use Zone:
Address: PO BOX 134
0304-266
To
City: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: APRIL 9, 2004
POST IN A CONSPICUOUS PLACE