05-3052 (SFD)P.O. BOX 1504
78-495 CALLE. TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-00003052
Property Address: 54625 AVENIDA DIAZ
APN: 774-1263-017-6 -000000-
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: COVE RESIDENTIAL
Application valuation: 119117
--Applicant:
Architect or Engineer: V
Lic. No.:----------1-----
Owner:
THOMAS BUFFIN
P.O. BOX 134
LA QUINTA, CA 92247
� a
Contractor:
SEP 2 2��5 )CONTEMPORARY HOMES INC
7{5271 STARDUST LANE
INDIAN WELLS, CA 92210
OFIaP`(lV,Ny6► (:760) 568-1404
C�_,AmGEaLic. No.: 736920
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/19/05
------------------------------------------------------------------------------------------- - - -
=--
LICENSED CONTRACTOR'S 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 Class: 13 License No.: 73 920
- �'
�aa�Contrracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her'own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
( 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
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.
l4ave 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 and policy number are:
Carrier STATE FUND Policy Number 1576408-2005
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' comp nsation provisions of Section
3700 of the Lab Cod , I shall fort) i t comply with visions.
Dai. •Z� �_ aht:'
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmlesstheCity
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned pr y, r inspection urposes.
- DaY ' 7,7
1 • d -fl. ature (Applicant. or Agent):
v
LQPERAIIT
Application Number . . . . . 05-00003052
Permit
. . .
BUILDING PERMIT
Additional
desc . .
Permit Fee
. . . .
709.50
Plan Check Fee
461.18
Issue Date
. . . .
Valuation
119117
Expiration
Date
3/18/06
Qty
Unit Charge
Per
Extension
BASE
FEE
639.50
20_.00•
----------------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
70.00
Permit
. . .
MECHANICAL
Additional
desc . .
Permit Fee
. . . .
59.00
Plan Check Fee
14.75
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
3/18/06
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
1.00
9.0000
EA MECH'FURNACE
<=100K
9.00
1.00
9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
3.00
6.5000
EA MECH
VENT FAN
19.50
1.00
----------------------------------------------------------------------------
6.5000
EA MECH
EXHAUST HOOD
6.50
Permit
. . .
ELEC-NEW RESIDENTIAL
Additional
desc .
Permit Fee
. . . .
106.73
Plan Check Fee
26.68
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date
3/18/06
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
1918.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
67.13
480.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
9.60
1.00
----------------------------------------------------------------------------
15.0000
EA ELEC
TEMPORARY POWER POLE
15.00
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 135.•00
Issue Date . . . .
Expiration Date 3/18/06
Qty Unit Charge Per
BASE FEE
11.00 6.0.000 EA PLB FIXTURE
Plan Check Fee . . 33.75
Valuation . . . . 0
Extension
15.00
66.00
v
Application Number . . . . . 05-00003052
Permit . . . . . . PLUMBING
Qty Unit Charge
Per
Extension
1.00 15.0000
EA PLB BUILDING SEWER
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
1:00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 9.0000
EA PLB LAWN SPRINKLER SYSTEM
9.00
6.00 .7500
EA PLB GAS PIPE >=5
4.50
1.00 15.0000
----------------------------------------------------------------------------
EA PLB GAS METER
15.00
Permit
GRADING PERMIT
Additional desc . .
Permit Fee . . . .
15.00 Plan Check Fee
.00
Issue Date . .
Valuation . . .
. 0
Expiration Date
3/18•/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
-----=----------------------------------------------------------------------
Special Notes and Comments
1918 SF. SFD PERMIT DOES NOT INCLUDE
BLOCK WALL, POOL/SPA
OR DRIVEWAY
APPROACH
----------------------------------------------------------------------------
Other Fees . . . .
ART IN PUBLIC PLACES -RES
20.00,
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
46.12
DIF FIRE PROTECTION -RES
97.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI) - RES
11.91
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged
----------
Paid Credited
--------------------
Due
-----------------
Permit Fee Total
----------
1025.23 .00 .00
1025.23
Plan Check Total
536.36 250.00 .00
286.36
Other Fee Total
2483.03 .00 .00
2483.03
Grand Total
4044.62 250.00 .00'
3794.62
LQPEPWIT
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District �o
47950 Dune Palms Road < BERMUDA DUNES
U= RANCHO MIRAGE
Date 9/27/005 La Quinta, CA 92253 INDIAN WELLS
NO. 27698 di}�PALM DESERT
LA QUINTA
(760) 771-8515 %INDIO yam`
Owner Thomas Buffin APN # 774-263-017
Address Jurisdiction La Quinta
City Zip Permit #
Tract # Study Area
Type Single Family Residence No. of Units 1
Lot # No. Street
Unit 1 54625 Avenida Diaz
Unit 2
Unit 3
Unit 4
Unit 5
S.F. Lot # No.
1918 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Comments CC#361343 in the amount of $4,296.00 plus 32 cents changes = total below.
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 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. 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 $2.24 X 1,918 S.F. or $4,296.32 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/Rabobank - Amanda Valez
By Dr. Doris Wilson
Superintendent
Fee collecte
Signature
Name on the check
Check No. 361343
Telephone
Funding Residential
lP
Payment Recd
r
$4,296.32 wer/Uridfer
NOTICE: Pursuant to Government Code Sec I 6020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r 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