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0305-261 (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 634981 B Date - z- 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 am exempt under Section ' , B&P.C. for this reason Date i 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, STAT9Fi.IAB13 Policy No. - 15420 743 (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' comperisation provisions of Section 3700 of the Labor Code; I shall forthwith comply with those.prgvisions. Dae: " Applicant 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 forfinspection purposes. Signature (Owner/Agent)`Date—'` - > BUILDI_ G-,P:ERMIT ; PERMITN N 0305-26'1 DATE VALUATION�y.q s�ppyy pp- qtt' LOT �j TRACT 7� y .2 LY, 5 JOB SITE ADDRESS 51_-4 CALLF, 31'1 .&NIPME APN 770-1.63-M1 1. OWNER CONTRACTOR / DESIGNER / EN INEER 1HOMA11; F3UFr-JW CORONMI C".C. NSTiRILKMON P.O. BOX 134 51-10'5 AVIRM� AVI 7 MI 01 LA Q)UJN TA CA, 92253 LA QTJWTA CA 92253 (160)564.4604 C1319 2261. USE OF PERMIT J?S9 S.F. u.fD PERMIT DOn lidl- INCLUDE HLOC;.K "taJALL, POOL OR DR-11VE WAY APPROACH. 15% REDUCED PLAN CHECK FE FOP, MULTIPLE E PLA;'NS OF .aA.MG' YPIX T1 ACT t"C.3lya'!'RUC TITIN 11789.00 SF PORCHIPA T 10 I.Q:0i1 u P GAU01{><t;•ARPORT494,00 SF Els'1{u"TM 0097' OF Cr01WRVC -ff0N 1.07,0711.30 :PXT^ t%° 6 'R SUMMARY Cr014Xf R.0CTION FET 101-000-4184000 $6671SO PLIAw t HEICK Petr 01-000439418 $1381-912 FEE DEPOSIT 201-x000-439.318 4250.00 WCHANIC13.LP , 101,-G�9R1-�2S-d�OQ. 9.00 EUC T'RICAL FEE 101 aG9.{30420.000 $121.00 PLUMBING FEE 101-0004'1.9-000 $124100 STR�/Oyy`-gi�yt�yy��ryryYyy�1OyT1014ITZ-TLESJD I-Oyt-I�/0yy0S�S���i-241.000 Silt�.``h�/� . S�d7��.RA4IINO Y.7:+E/ .2t�1'-6)1P4d' Li�"'t�V© 1S1°Jrpo DEV1111LOP.ER IMPACT FEE PR2C. ISE PLAW 101-000-4.Q41-34,3 $100,00 £1`UB$ "C TAL COVYMUC1100 AND PLAN C13FICX $3,640.32 TM- 3 PlIt -P.AM r,,& 00 421150100 ��lJ. °Jr P'1 FERN XXTE NOW AAlS 05103 IGI, -fik QlllAtiA RECEIPT-'_- /ATEd��� BY / DA;p FINALED INSPECT 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 41.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 — 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 I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines —!i 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: j Final Utility Notice (Gas) Z7, 9,,,,,V 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 Q Final Utility Notice (Perm) l/ Unit 1 9 51425 Calle Hueneme Unit 2 Unit 3 Unit 4 Unit 5 Comments 1789 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 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 1,789 S.F. or $3,828.46 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. 259129 Name on the check Telephone 760/564.4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon McGilvrey Payment Recd So.00 $3,828.46 Over/Under Signature c //X,-/ I on - 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 CERTIFICATE OF COMPLIANCE ��ZFIEDSC' Desert Sands Unified School District 47950 Dune Palms Road zq�cO o Q BERMUDA DUNES r Date 8/5/03 La Quinta CA 92253 (4 RANCHO MIRAGE d INDIAN WELLS ti No. 24778 (760) 771-8515 LM DESEFrr PALA QUINTA �y %INDIO Y� O Owner Thomas Buffln APN # 770-163-021 Address P O Box 134 Jurisdiction La Quinta City La Quinta Zip 92253 Permit # 0305-261 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 9 51425 Calle Hueneme Unit 2 Unit 3 Unit 4 Unit 5 Comments 1789 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 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 1,789 S.F. or $3,828.46 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. 259129 Name on the check Telephone 760/564.4604 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon McGilvrey Payment Recd So.00 $3,828.46 Over/Under Signature c //X,-/ I on - 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 -08-2004 07:35 AM pp' r.\'STALLATION CERTIFICATE it(, .Addriss u ,ti -nut number DUCT LEAKAGE AND DESIGN DIAGNOSTICS P.03 i'n %,1,-vn d'LJ_OUC_T LEAKAGE REDUCTION Ilrvsht!r:zat!on Tcst Results (CFM @ 25 PA) 1-.111 r io, k Test Leakage (CFM) —2 !!'Fin F!o\% to ('alctilatcd as 400 cfm/►on x number of tons, or as 21.7 x Heating Capacity in Thousands of BnA r, enter calculated value here — d value here Lc3ka6c Fraction = Test Leakage/(Measured or Calculated If fan now ismeasured, enter eFan Flow) = ' Pass if leakage fraction 5 0,06 ❑ Fur ,AEROSOL TYPE SEALANTS ONLY - The following diagnostic testing was completed; Pass Fail Duct Fan Pressurization at rough -in measured leakage (CFM) CHECK AFTER FINISHING WALL; ❑ `S ❑ 'i\`c ❑ Pressure pan test or House pressurization test C �%� �j CD v'> El Inspection ofDuet Connections � " /'/ Pass Fail THERMOSTATIC EXPANSION VALVA TXV W l : s ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access is provided for inspection OUCT DESIGN as Yes is a pass ❑ s Fail ❑ N"s ❑ No RCCA Manual D Design calculations have been completed, Duct Design is on the plans and duct installation matches plans. ) j� ❑Yrs ❑ No TXV is installed or Fan flow hes been verified, If no TXV, verified fan flow matches design from -CF - IR. Measured Fan Flow = Yes for both I and 2 is a PassC3[3Pass Fail I. ti;r undersigned, verify that the above diagnostic test results and the work I performed associated :unl�)rr 1,"Cc %%.:th the requirements for compliance credit. (The builder shall provide the HERS providers a copy of the CF -6R by 01e builder employees or sub -contractors certifying that diagnostic testing and installation meet the requirements for :��mplianrccred:t J Ile ';` Signature, Date d7r0%'�'ht nu:! Installing Subcontractor (Co. Name) OR '10 Building Dcparrment General Contractor (Co. Name) HERS Provider (ifapplicable) 2ui:ding Owner at Occupancy ;:,sk+4',tw5� ."-^-- . ter,.' ,•' ..a►._ � t �" r I ...' . REP.ORTO�F 'FIELD`CO�P�C . T'10 N - .. CLIENT:.--.---.-...—._- •.REPO:a. NO.: •i' :.. ... • .) ' -/U Jv SCk ..: a� ...:... PROJECT: tf DAILY SCALIBRATIONV vARlnnl�r; STANDARD i NUMBERS VARIATION. PEACE)rT-/- GAUGE AOJUSTMEN1. LEAK GAUGE INFORMATION AND U. --_— -I COUNTS "� FROM SHEETS __— ------i 18R'ATION I , •�\ I S: ':%AOI-STURE: I .tit OISTVRE: I :tit OISTV RE: IG'c-TY PE:.�R O-XLER/CJ+MP9 ELL MOISTV R_ ' DENS(T`:: DENSITY: OENS!TY: �'-• —' SEL NO.:D EN S MY: `l;:_ ,TOR INFORMATION =- - I MAX. ORY DENSITY, PCF` — OPTINIUNI -VOISi"U:?_ --- 'OIL IDT VISUAL CLASSIFICATION OF SOIL )MPACTION'I MOISTURE I GENERAL LOCATION:---- :aUIREMENTS. % I REQUIREMENTS. :CST READING QUOTIENT/ SOIL TESTELEVATION titGISTUR= WcT/DRY PERCENT I COhiu,tENTS F TEST CONTENT. I OENSI"Y, COM?ACTION JO. PCF IO NO. DEPTH. IN 0, I PCS-- — --I i I , [ :! F� 1 - !•�I •` I .. TECHNICIAN: ILL bTEFi�';L --`T ES7 RESULTS COMPLY WfTH SPL{:FICA TIONS ' ,0µ7.tEX7S•f�F 2 - BAC�Fl11 B -COMPACTION PEkCOrrAGE DOES NOT COMPLY tiY77"li SP£�FIC ATIONS ' J - aA_SE.COURSE C. - RET .S... OF PREVIOUS TEST a - SUBBASE O - MOLSTURE !N E cs!Ss OF SPECIFICATIONS 5 - SOIL CEM&YT E- MOISTURE BELOW SP£CIFICA710N5 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: Use Classification: Occupancy Group: SINGLE FAMILY DWELLING 51-425 CALLE HUENEME R-3 Type of Construction: VN Owner of Building: THOMAS BUFFIN Building Officia Bldg. Permit No.: Land Use Zone: 0305-261 RC Address: PO BOX 134 City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: APRIL 9, 2004 POST IN A CONSPICUOUS PLACE