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0304-270 (SFD)LICENSED CONTRACTOR DECLARATION AY hereby, affirm under penalty of perjury that I am licensed under provisions: of Chapter 9 (commencing with Section 7000) of Division S of the Business and PrGfessionals Code, and my License is in full force and effect: "License # Lic. Class Exp. Date 682.90 D'a`te ?1-�i2 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 contractorto 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. �(Y%) 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 STATE FUND Policy No. 229.9300737.20!' (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. ,Date:: ` ' ,"• Applicant— Warning: pplicant 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 o,pursuant'ito _ any permit issued as a result of this applicaton agrees to, & shall, indemnllsfyY & hold harmless the City of La Quinta, its officers, agents•and employee. 2. Any permit issued as a result of this application becomes null and vo1i i work is not commenced within 180 days from date of issuance of.s 01 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 buildinng construction, and hereby authorize representatives of this City.to enter upon the above-mentioned property, for;inspection,purposes; Signature (Owner/Agent) �° r Date BUILDING PERMIT PERMT# �' DATE VALUATION y; -" •' LOT TRACT :6 BLX 706 JOB SITE ADDRESS- AYtaA V1W. A APN 7.74-M.3"018 OWNER CONTRACTOR/DESIGNER/EN (NEER "fF + tv DAVID 'L.1401HNc�`Ct�� RO,BOX 13" � :.... , �1=7�a.i3��11hC�a3C*�.�'3R. ]A C,�U'fWlA CK 92253 BMWIDA DITIMS CA 92261 (760 408 528 t; f3lAq 3724 USE OF PERMIT �.. fg f �p g ; A•r�t �y y • a7.��dr•:w F'.�' V,t.�.fo ]i d..9 Vtl �.i.. ��'7�.i_ � _ _ � . •, ,: _ _ _ �. 1436 S. V. ;ii O IMP -MIT 13Ci&S pZO7P'ItJ`CI. MP, B%fa=, X71 INLI, Poot. OR" ' I'�RylVEWA'" APPROACH.`F3% Di.3d0 UT.'-'muL,7°I -z PCS Ii 'TTS OF Wig 01,AIt TRACT" CONSTRU101T'yON" 1AX09 S PO tCHIPA' IO: 144.00 SP 0A.IIA.CIIIlC'rARPOR,Y "• '490.00 81'i 01,09T OF G(NNSTRLTC"ITON 69A1;4.4,(X) fi'mar M si'Titi mw C(DHSTRUC TION YEF . 101-000 41 B-000 MAN CH.=k k Mt 101-000,439-3111 $12s.iI IEE DEPOSIT MECHA141C.A1..I 1.01-000-421-000% $32.50 EUC'I'I.1C.AL FEE " 101.000-420-000 $108,56 PLUMB119471ZE 101-000.419-000 STRONs:I'M tIi?Nf M&-•,,kL?81 s ,:101.000=2,41„00p" ORAD.P.4 3 FEE . • ,.. 1.01:-000-423-000 DEV RLOPER iMPAIC:T 311:;1;-0 i6kA 0.00 PRECISE PLAN 101-000-4414-345' $100.00 3 (:01d TJC'n0.Nf AND PI ALT CM -CIC MAY 2. 3 20.03 : UI CiTV OF LA QUIRTA FINANCE DEPT. RECEIPT DATE' BYDATE F NA !NSP C t'r �0 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs O Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing 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 BLOCKWALL APPROVALi 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 Linesby 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 _`�G_0/ 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 Q Utility Notice (Perm) COMMENTS: _ Building Address � Owner .._, Mailing n Address PG, 43 G X City Zip// / .,GJN 61, t//,J� .r/i4/ tractor ^ _ - T -4i t Ty/ 4 P.O. BOX 1504 78-495 CALLE TAMPICO 11-1-A LA QUINTA, CALIFORNIA 92253 030 `�' °2 ?° b APFLICATION ONLY BUILDING: TYPE'CONST'.! OCC. GRP. �% A.P. Number 774 — (96 0/O _ Tel 417O Legal Description (iQ (p t0 Alj f Project Description Address/ 7 �) �2�/�✓ F ` Cit V Zip 'C Tel.. /� yam 7 d State Lic.r � n / City &Classif. vL �( c/o Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 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,Business 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 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). I", 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'I 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.) I'! I,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 fl Copy is filed with the city. ❑ 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.) Icertify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: 9, 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. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address 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. 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 city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip C WHITE = BUILDING DEPARTMENT Sq. Ft. lq,3( No. No. Dw. Size `-// > Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT r ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street SEtback from Center Line Side Setback 'rom Property Line FINAL DATE INSPECTOR Issued by: Data Permit Validated by: Validation: YELLOW = APPLICANT PINK = FINANCE , =" CERTIFICATE OF COMPLIANCE FIED Desert Sands Unified School District �ctti 47950 Dune Palms Road Q BERMUDA DUNES Date 5/22/03 La Quinta, CA 92253 rn RANCHO MIRAGE Cf INDIAN WELLS DESERT 24449 760 771-8515 LAQNT s y + INDIO Q vJ Owner Thomas Buffin API* 774-063-018 " Address P. O. Box 134 Jurisdiction Lai Quinta City ' La Quinta Zip 92253 Permit # 0304-270 Tract # BLK 206 Study Area Type Single Family Residence No.'of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 6 53125 Avenida Villa 1436 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 petios/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 th a 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 1,436 S.F.: or $3,073.04 have been paid for the property listed abov6 and that : building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. r Fees Paid By CC/Valley Independent Bank - David Addington Check No. 28:201 Name on the check 7Telephone 760/408-7528 ; Funding Residential By, Dr. Doris Wilson Superintendent Fee collected /exempted by ,Sharon McGilvrey $3,073.04. o.00 Payment Recd Over/Under Signature NOTICE: Pursuant to Government Code Section 66'020L(/this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on whit_ h those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf; whichever is earlier. NOTICE: --This Document NOT VALID if Duplicated , • Embossed Original - Building DepartmenUApplicant :: Copy - Applicant/Receipt Copy - Accounting �� `r, RECORDING REQUESTED BY: Fidelity National Title Company f Escrow No. 46213 -CB Title Order No. 822757 • When Recorded Mail. Document and Tax Statement To: William -Thomas Buffin P.O. Box 134. La Quinta, CA 92253 -063-01B-9, -, - - A = - -5, - ; I FOR RECORDER'S USE f DEE The undersigned. grantors) declare(s) Documentary transfer tax is .$ City Transfer Tax is $ [ .l computed on full value of property.conveyed, or [ ) computed h"'full value less value of liens or encumbrances remaining at time of sale, [ ] Unincorporated Area City of La Quinta FOR. A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, Contdmpory Homes, Inc., a California.. corporation . hereby GRANTS) to . William Thomas Buff in, a.married man as his sole and separate property and Power. Finance Associates,, Inc., a California corporation the following described real property in the City of La Quinta, County of Riverside, State of California: SEE EXHIBIT ONE ATTACHED HERETO AND MADE.A PART HEREOF DATED: March 11, 2003 STATE OF CALIFORNIA ; ,COUNTY OF Robert Kellogg 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 �� COP 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 AS DIRECTED ABOVE FD -213 (Rev 7/96) GRANT DEAD ` RC- DISTRICT.- PLANNING REVIEW FORM . l This .form is to be. used by CDD staff for review of single .family dwellings in the RC (Cove Residential) District 'per. Section 9:50.090 of the Zoning Code. Its purpose is to. determine: 1►. that -the proposed housing design does not duplicate the same architectural .style of any house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for -Master Design Guidelines: If the applicant does need to file a .Master -Design Guideline, please transmit this information to the Building and Safety'Department as part of your correction list. Please . , attach additional explanations as necessary. APPLICANT: SITE ADDRESS: ";573 APN 0( 015 CASE NO.: CD3 LEGAL:. LOT BLOCK CO UNIT S.C.@V.L•.Q. CHECK AND APPROVED BY: iDATE: 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 COMMENT/CORRECTI-DN Verify legal and APN information Consistent with MDG on file (as applicable) e50 MDG filing required (5 filings since 9/3/98) ��Q v� /. Architectural variety within 200. surrounding feet of the ding area Architectur�Iesign-featutes Sto0 a58 .A6010 O .nth G Other Requirements: OCT-06-2003 06:21 AM P.01 , CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF-4K Date Project Title /l j Civ e,.-. Proje Aodr ss guilder Name Bonder Cont t Telephone Plan Number 57.2 3 ZHERRatere j o e Sampte Group Number g ing SignatureSampleHouse Number ir; .rG ¢ sOGi HERS Provider //G,�-�S�OGI s Street Address: Cltylstate/zip" 4 o u 117 g s,r d- Copies to: Builder, HERS Provider HERS RATER COMP ANCE SI&TEMENI The house was; Tested Approved as part of sample testing, but was not tested As the HERS rater providing dlagnostic testing and field verification, I certify that the houses identifteo on this form com y witn the diagnostic tested 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 of ducts) where cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination r with cloth backed, rubber adhesive duct tape 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 a00cfm/ton x number of tons enter y calculated value here^ If fan flow is measured enter measured value here • Leakage Percentage (100 x Test Leakage/Fan Flow) _ Check Box for Pass or t=ail (Pass=6% or less) cl Oass'LFail THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) is installed and Access Is provided for inspection Yes Is a pass Pass Fail L�MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 , O Yes D No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in . .4 CF-1 R and design on pian. 32. ❑-Yes 0 No .TXV is installed or Fan flow has been verified. If no TXV, �� , • verified fan flow matches design from CF-1 R. Measured Fan Flow = _ Yes for both 1 and 2 is a Pass ,PassFait " JUL 02 '03 17:08 FR TO 9-7777011 P.02i08 Information •TO&MOn Errgineert�ng • Gonsalting •Testing REPORT OF FIELD COMPACTION TESTS ESTED FOR: DAVE ATTINGTON PROJECT; 53125 AVE VILLA POWER BROKERS LA.QUINTA, CA PO BOX 134 LA QUINTA, CA 92253 )ATE: June 17, 2003 OUR REPORT NO: 073-30219-2 'EST DATA: (1) Light brown silty sand, fine to medium. OPT. MOIST. = 10.J' MAXIMUM COMMENTS' TEST TEST SOIL ID LAB DRY * WATER WE"- DRY PIcRCENTPeC . 9O M1ri NO. DEPTH ELEVATION NUMBER — DENSITY CONTENT DENSIrY DENSITY COAPACTION S 1 8" FG 1 119.0 10.0 125.0 117.:3 98.6 1 - A 2 BPI FG 1 I 119-0 101.7 .12i.2 114.9 96.6 1 - A 3 811 FG 1 119.01 12.9 13C.5 115.6 97.1 1 - A .............- 4 8 ,I — FG _- �. - - 1 119.0 -- 15.3 — 12E.0 108.4 I ..... 5P1 _ 1 1 - A rj B" FG 1 119-0 15.1 12E.8 111.9} 94.0 1 A TEST LOCATION: House pad finish grade -- 53-125 Avenida Ville 1 NE end 2 SE end ` 3 SW end �__..W_... _._.—.-----•--•-••- ............. .............. -.......--._..__..._..._..___......_ 4 i NW end 5 Center IOTES: TESTS PERFORMED PER ASTM 02922.96 & ASTM D3017-96 'COMMENTS: 1. FILL MATERIAL A. TEST PESULTS COMPLY WITH SPECIFICATIONS' DENTSEITIGES SHOWN: Lbs. per cuibYic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT COMPLY PERCENT COMPACT ON Basad onreMaximum dry 4; �ESACOEUR;.E C. RETEST OWIPREEVIpONS SUSS�TEST soil IDrynumber� on sample indicated try S. OTHEREMEN i D. MOISTURE BELOW SPECIFICATIONS SPECIFICATIONS * (1) ASTM D1557-00 METHOD A I i EST INSTRUMENT: STANDARD COUNT M: D: 2EMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA -M: D: TECHNICIAN_ Vicki Drover Respectfully submitted, Processional Service Industries, Inc. 1(ESE TEST RESULTS APPLY ONLY TO TME SPECIFIC LOCATIONS NOTED AND NAY NOT REPRESENT ANY OTNER LOCATIONS CR ELEVATIONS. IEeQpT6 MAY NOT BE REPRODUCED. "IC90T IN FULL, WITHOUT WRITTEN Pp RM$SION BY PROFESSIONAL SERVICE NOUSYRIE& INC, ; Professional Service Industries, Inc, • 42-240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 760/311-5750 • Fax 760/341-5794 'SI A-100.2 (4)F - .' Y C J N �:Oj � � edificatd:o:f ccupanpy14 RAIM -� -� G��oF.�9 .. , • �� . �Building..�&.Safety Department •. F. V � ; r two y -. , ` c, , . J - � � t � `�, • u - � This Certificate is issued pursuant -to` the,•requirements-of Section 1,09 of the California, Buildingr- Code, certifying that, ,at •-the tine of issuance,,, his` structure- was :in .compliance. with' the ,,,provisions, of the Building, Code sand 'the variouS.0 ances of the ` CityJ regulating building' construction' and/or use., , y � � `� ' F, ~° •� � � �� V.BUILDING�ADDRESS.,53-125 �Avenida.Villa' Use ,classification: Single Family:Dwellirig `Building `Permit No.: 0304-270 �'• Occupancy�Groupw:.�R 3 � � .4# V • Type 'of Construction` VN'(Land Use Zone; RC ' i - � r •!- err i^ � - .,,Owner,of.Building`Thomas Buffir%�, �� y' `� _ •' s • �; °'Address: P:0:Boz=134 , � r, •� _ •• "; , , . � � �, : "-.; F� City, ST,zP:'La Qui ntarCA 92253 .... • � • �� A�, << � y� , - gy <.Daniel,P. Crawfo4 Jr Date. 10/14/03,- ��.. Building Offieia � ;,^r � �_ �� ' ., � • .;<. _' �,�� s ^� _.. , �� ., , ,�:;- '"�` '-�. , rs S ti l� •POST.IN A CONSPICUOUS PLACE + .' Y C J N �:Oj � � edificatd:o:f ccupanpy14 RAIM -� -� G��oF.�9 .. , • �� . �Building..�&.Safety Department •. F. V � ; r two y -. , ` c, , . J - � � t � `�, • u - � This Certificate is issued pursuant -to` the,•requirements-of Section 1,09 of the California, Buildingr- Code, certifying that, ,at •-the tine of issuance,,, his` structure- was :in .compliance. with' the ,,,provisions, of the Building, Code sand 'the variouS.0 ances of the ` CityJ regulating building' construction' and/or use., , y � � `� ' F, ~° •� � � �� V.BUILDING�ADDRESS.,53-125 �Avenida.Villa' Use ,classification: Single Family:Dwellirig `Building `Permit No.: 0304-270 �'• Occupancy�Groupw:.�R 3 � � .4# V • Type 'of Construction` VN'(Land Use Zone; RC ' i - � r •!- err i^ � - .,,Owner,of.Building`Thomas Buffir%�, �� y' `� _ •' s • �; °'Address: P:0:Boz=134 , � r, •� _ •• "; , , . � � �, : "-.; F� City, ST,zP:'La Qui ntarCA 92253 .... • � • �� A�, << � y� , - gy <.Daniel,P. Crawfo4