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9906-038 (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 'st#A ��Lyyic. Class Exp. Davey 0813Vt n� 20( Datg f _ aQ' p 71` fl 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: o ( ) I, as owner of the property, or my.employees with wages as their sole compensation, will do the work, and the structure is riot 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). ( ) Lam 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. 1 ( ) 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. S'TrA'd% FL.YNT) (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'-provisio s' Qate: f %'. `f f APPli - nt, f� 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 cancellafion..-� 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 for in`sp°ection purposes. Signature (Owner/Agent) M Z`C 4"'d� ✓ Date BUILDING PERMIT PERMIT9x�Q3x DATE VALUATION S91 .r)3&7() LOT E TRACT elk 32. U2 JOB SITE5.E-,95555 f.���,�..NIDA DJAZ ADDRESS APN 77XISS-018 OWNER CONTRACTOR/.DESIGNERENGINEER A QLJNTA PAI.)pNyR ILLyAIN'1 11.1,fLi, wOGERS: 1 51-370 AVENIDA.BERMUDAS -5&900 JACrWN LAQP1NTA CA 92233 7"HERA4AL CA 92274 (76())399-1200 CAL# 1954 USE OF PERMIT MOLE FAMILY DWIELLIN ,`H I3 - i?U"T DOES NC)T INCIZIE)E .1aLOCK WALT. OR POOL. L� P-BA.t MAS` ER PLAN. r' iiv�C"1 GCa7S'is itC.eiGi 1.475.61) 3.1' I'U�C4i711A'TiU 58.00 3t' CUA tAGFJC. ARP0Wr 463.00 SF 5 FT. WOW FE NCE 200.00 L ES T 1,.A Lk a C1M �e.� li.ST O &' CONS Y.RI C fl IGI Y 91.1,63&70 )P1 RIAM' F,t E 5134 4ARY , (,'O N3T1t1:1r:,7110.N T'FE f: Io1-0fiC1-41.i -000 �6C►3.ti;� IECt1;Ai'31's"AT. ,ems qui Y000�•�l S-OOC $66.50 ELEL'T.RiCAE. FCC. 5130:39 €+l'.i14 ama am 101-000-419-Qf) $133.50 S'T"#'t13;4Wz!01,-W-241-0W GRADYNTO FEE 101.,0004 3.000 X24.0© tNT,12AS`fRifc`<T1i'Rr F Ef3 22,5-000-44-4-341. ffi� ii£t6.46 Pf31 CTSCPLAN 101A)0U-441-345 ` f~ � Ufif'�Sf'►' 10 a _OOO�d39.31 S �3ASi3..M � .. +r + ,G1 COi ?`�?� s. cJr . Nt ���� C F f ND -10 LESS PRE' -RAID FEES 53,W 42450.000 FEES OVE NOW $3,158.41 RECEIPT ��1TE BY'd 9� DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings �Ducts Underground Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Faris O.K. to Wrap F.A.U. Framing 46 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 4 Drywall - Int. Lath F44. Final Final en 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) (yU 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: 0 t P.O. BOX 1504 AP Ll I NLY Building k I — '� A\1 \' 78 495 CALLE TAMPICO Address O _SIJJ f LA QUINTA, CALIFORNIA 92253 Owner L .c1 (11)1 N W PIA (tT Nec Mailing Address City M Address . eN City Zip Tel, lir 1.61f1 L- I�c/ l State Lic...t City & Classif. d_1Cq 1 '� �� Lic. # Arch.,'Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,BUSlnesS and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1: 1, 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, 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 1 I, 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.) Il 1 am exempt under Sec. B. & 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 n Copy is filed with the city. O 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 the work for which this permit is issued, 1 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. .DING: TYPE•CONST. OCC. GRP. Number -)b `` 7 4 ( I Description frQT r G. 13w::A 3 Z, is N r 2. Ict Description X IIs: -773 -155 - oiA Sq. Ft. I / , N / No. Dw. Size r- f % S Stories ries Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the i work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name . PERMIT I AMOUNT Plan Chk. Dep. , L_so — n j Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from lFenter Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line Lender's Address/ FINAL This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 'el I certify that I have read this application and state that the above information is `correct. by I agree to comply with all city and county ordinances and state laws relating to building construction, hereby this /Issued -1 / and authorize representatives -of city to enter the above- mentioned property for inspection purposes. .� ` ( Validated Signature of applicant Date f Irl/ i Mailing Address ValIdatio City, State, Zip 'i WHITE = FINANCE YELLOW = APPLICANT INSPECTOR -Date Permit Y*. 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 CERTIFICATE OF COMPLIANCE Date 7/22/99 APN # 773-155-018 No. 19071 Jurisdiction La Quinta Owner NameLa Quinta Partners No. 51-855 Street Avenida Diaz City La Quinta zip 92253 Tract # BLK32 U2 Lot # 6 Square Footage Type of Development Single Family Residence Comments Permit # Log # Study Area 1,475 No. of Units 1 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 th&am&,,nt of 1.93 X 1,475 or $ 2,846.75 the property listed above andhat buUlding permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued Fees Paid By ccNIB/Tom Buffin TeleQhone Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Juanita Green Signature Payment Received $2,847.00 Check No. 195217 NOTICE: Pursuant of AVsembly 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 above 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 collect 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.25.1999 8:46AM COMMONWEALTH NO.706 P.1/1 RSCORDYNG REQUESTED EYc CHICAGO TITLE COMPANY COMPANY 99.8738KC 97056040 WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TOc WILLIAM THOMAS BUFFIN P.O. BOX 134 LA QUINTA, CALIFORNIA 92253 GRANT DEED AFNt 773-155-019 O'S The undersigned grantor(s) declare(s); Documentary transfer tax is $16.50 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of sale. ( ) Unincorporated area: ( ) City of , and FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, FRANK J. GALGANO, hereby GRANT(S) to WILLIAM THOMAS BUFFIN, AN UNMARRRIED MAN DHA LA QUINTA PARTNERS the real property in the City of LA QUINTA, County of Riverside, State of California, described as: Lot 6 in Block 32, Unit No. 2, Tract Santa Carmelita at vale La Quznta, as per map recorded in Book 18, Page(s) 55 inclusive of maps, in the office of the County Recorder of said County. Dated June 25, 1999 State of California County of } S.S. On before me, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose names) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. Signature MAIL TAX STATEMENTS TO: FRANK J. GALGANO 0 (This area for official notarial seal) RICCORDiNG REQUESTED 8Yc CHICAGO TITLE COMPANY COMPANY 99.8738KC 97056040 WHEN RECORDED MAIL THIS DEED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO z . WILLIAM THOMAS SUFFIN ' o' P . 0 . BOX 134 LA QUINTA, CALIFORNIA 92253 0 GRANT DEED A4N� cc 773-155-0/18 The undersigned grantor (s) declare (s) s C7 `J "5 Avg Documentary transfer tax is $16,50 (XXX) Computed on full value of property conveyed, or ( ) Computed on full value less liens and encumbrances remaining at time of sale. ' ( ) Unincorporated area: ( ) City of and • 4 FOR A VALUABLE CONSIDERATION;,' receipt of which is hereby acknowledged, FRANK J. GALGANO, hereby GRANT (S) to ta;,k:^ WILLIAM THOMAS BUFFIN, AN UNMARRIED MAN DBA LA QUINTA PARTNERS the real,property in,the City of'LA QUINTA, County of Riverside, State of Califorii a, described'a4: Lot 6 in Block 32, Unit No. 2, Tract Santa Carmelita ,at'Vale La Quints, as per map recorded in Book 18, Page(s) 55 inclusive of maps, in the office of the County Recorder of maid County. Dated- June 25, 1999 State of California County .of ) S.S. On before me, personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are 6ubscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the persons) acted, executed the instrument. WITNESS my hand'and official seal. Signature MAIL TAX STATEMENTS TO: FRANK Z. GALGANO (This area for official notarial seal) B RC District - P/annina Review Form This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of compatibility. issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: LA QUIT?TA PARTNERS— LARRY ROGERS — SHIELDS PROJECT ADDRESS: 51-8-55 Avenida Di a7 APN: LEGAL:, LOT'_��_, BLOCK UNIT Z- , S.C. @ V.L.Q. CK'D BY: Stan Sawa BIN NO:.. CASE NO. 99-77 ..CHECK -DATE: Inform. the assigned Building plan checker upon your assignment to this case. The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N I COMMENT/CORRECTION �.: 1.W- ..:'. ti,.I.N{ �..:ri :> ,<, ::...<� :x.z::. �.. ,; :<:v:> €� •,7.f4�iT.F•VT4��.u��'.�4y':.ti\:44p\��',\,iw itr`.•.].L•nQ�`n�'+..\``••;•i.2v:*L':\t:L•T:iv\•.+•<fi.•.�x•}T:„\ Case logged and number assigned. Verify legal and APN information. Consistent with MDG on file las applicable) MDG filing required 15 + filings since 9/3/98.) Consistency -with-street/surrounding area:. Colors Materials Architecture . y a Ce; OTHER REQUIREMENTS: The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building & Safety address file. BA -1 ELECTRICAL LOAD CALCS DESCRIPTION CKT VOLTS CKT AMPS NO. OF jVOLTS-AMVS7TOTAL UNITS PER UNIT VOLTS -AMPS 120 V. MULT OUTLET CKTS GEN LTG @ 3 W PSF 120 15 1475 3 4,425 SM APPLIANCE CKTS 120 20 2 1,500 3,000 GRI CKTS 120 20 1 1,500 .1,500 SUBTOTAL 8,925 120 V. SGL OUTLET CKTS DISPOSAL 120 20 1 2,400 2,400 DISHWASHER 120 20 1 2,400 2,400 LAUNDRY 120 20 1 2,400 2,400 HOOD 120 3 1 360 360 SUBTOTAL 7,560 FIRST 10,000 V-A @ 100% 10,000 BAL V-A @ 40% 2,594 SUBTOTAL 12,594 RANGE 230 40 1 9,200 9,200 A/C (LARGEST-FAU OR A/C 230 30 1 6,900 6,900 TOTAL V-A 28,694 SELECT SERVICE SIZE TOTAL V-A 1230 VOLTS 28694 230 124.7 AMPS t� 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: SFD 51-855 AVENIDA DIAZ R 3 Type of Construction: VN Owner of Building: LA QUINTA PARTNERS Building Official Bldg. Permit No.: 9906-038 Land Use Zone: RC Address: By: STEVE TRAXEL Date: 02-24-00 POST IN A CONSPICUOUS PLACE M% iff F Inform mon /r�� ®To Build On Engineering • Consulting • Testing REPORT OF FIELD COMPACTION TESTS TESTED FOR: LARRY SHIELDS PO BOX 3578 PALM DESERT, CA 92261 PROJECT: x_5.1-855 AVE DIAZ. LA QUINTA, CA DATE: August 02, 1999 OUR REPORT NO.: 073-90188-2 TEST DATA: (1) Fine to medium sand. OPT. MOIST. = 11.09. TEST NO. TEST 'DEPTH ELEVATION SOIL ID NUMBER MAXIMUM LAB DRY * DENSITY WATER CONTENT WET DENSITY DENSITY PERCENTI COMPACTION COMMENTS' gpec . 90% Min 1 811 FG 1 119..0 10.6 .120.7 109.191.7 house 1 - A 2 81' FG 1 119.0 10.9 121.0 109.1 91.7 1 - A 3 811 FG 1 119.0 10.5 119.9 108.5 91.2 1 - A 4 811 FG 1 119.0 10.1 122.5 111.3 93.5 1 - A TEST LOCATION: 1 SW corner of house pad. N2 NW corner of house pad. 3 NE corner of house pad. SE corner of house pad. NOTES: TESTS PERFORMED PER ASTM D2922-96 & ASTM D3017-96 ' 'COMMENTS: 1. FILL MATERIAL A. TEST RESULTS COMPLY WITH SPECIFICATIONS DENSITIES SHOWN: Lbs. per cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT COMPLY WATER CONTENT: Percent of dry weight3. BASE COURSE WITH SPECIFICATIONS PERCENT COMPACTION: Based on maximum dry 4. SUBBASE C. RETEST OF PREVIOUS TEST density obtained on sample indicated by 5. SOIL CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS soil ID number. 6. OTHER E. MOISTURE BELOW SPECIFICATIONS * (1) ASTM D 1557, Procedure A TEST INSTRUMENT: STANDARD COUNT M: D: REMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: D: TECHNICIAN: Juan Nunez THESE TEST RESULTS APPLY ONLY TO THE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS. REPORTS MAY NOT BE REPRODUCED, EXCEPT IN FULL. WITHOUT WRITTEN PERMISSION BY PROFESSIONAL SERVICE INDUSTRIES, INC. PSI A• 100.2 (i)F Respectfully submitted, Professional Service Industries, Inc. Professional Service Industries, Inc. • 42-240 Green Way, Suite C • Palm Desert, CA 92211 + Phone 760/341-5790 • Fax 760/341-5794