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0304-269 (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 # L'ic. Class Exp. Date 682901 33' 1%131.1 f ll Date �' Signature of -Contractor ? �' �� e� ` OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that l am.exempt from the Contractor's License Law for the following reason: ( ) 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•& 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. ( ) 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 pdrmit is issued. My workers' compensation insurance carrier & policy no..are: Carrier STAU ruND Policy No. 2223- 001M20,03 (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 thoseprovisions. Date: — Applicant rr ` Z Warning: Failure to secure.Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Buildingand Safety for a permit subject to the conditions and restrictions set forth on his application. 4 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit,issued as a result of this applicaton agrees to, & shall, indemnify' ► & hold harmless the City of.La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if, work is not commenced within 180 days .from, date of issuance of such - permit, or cessation of work for 180 days will subject Permit to.cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the, building construction, and hereby authorize representatives of.this City to enter upon the above-mentioned propepy for inspection purposes. l,r, Signature (Owner/Agent)" -�� Date pin BUILDING PERMIT PERMITp DATE VALUATION' LOT'. TRACT HLIK 206 7 w f JOB SITE ' ADDRESS1n,' AQ 'r�V'I. . APN 774 -MI -019 OWNyEgR�ry CONTRACTOR /PESIGNEER/EN1NEER py[ 2A"X\,.,(.tl]L'1�7 C16•.Cdl4 � S. DAML. AJ7yqQT00. 41«1$D1�.�..�WT+�.WTSR ' CA 92253 Fs��.tMUTDA;T.3Y.7NFS CA 92201 (760)408.7528 C.81,et 3 724 USE OF PERMIT t € Y.n F J.LY mmui4o '436 S:I.:£9i;Y'Wlii.i; POOL. OR DDl;ttfEWAY.d PPROIACI3 TRACT CONSTRUCTION 1,436.00 OF J PORCWPATrO • 9780 Sir 4 0ARAGIUCA"OR.T 491j.00 Si+ PFRNMETE SOURAWARY CONS T iRUC7 iON FEE 101-0001,418-000- $590,00 PLAN C HWK: P -EE • 101.0130-4:19-31 8 �19'i. fD2 FEE DEPOSIT 1.61-000.439.318 4230100 It11} 9 it+llt;A'b.', i�G� 101-000.421-006 $52.50 ELECTRICAL FEF". pL11N`AIM!I it U .. 101.000.419-000 STROIN-0 MOTION FEE, - RES.ID i 01.00044 f-000 HID ORADINO ". 0l "000-X23-0170 DEVEI,,OP ;R IMPACT FEE :. $2,405.00 iPRECISZPLAN 101-000-441-345 �inis.u0 1GT1011 AND Puw CAEC .' r, -P PMES $3,889.57 $250.00 MAY: 9 2 2CQ3 �J0V 7.1S DAA i�0%N1. CITY OF LA dUINTA' � s: r FINANCE Lf RECEIPT DATE BY DATE FINA ED INSP TO 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 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 41_ Drywall - Int. Lath Final Q Final 1WV W le 4 BLOCKWALL APPROVA S Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Waste Lines 6- p Gas Test Electric Final 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 Q 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 / 3 Utility Notice (Perm) I v COMMENTS: ± Building Address Mailing Address 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO 3 " r/� LL. /✓ LA QUINTA, CALIFORNIA 92253 Contractor o3oy• �G q . .��. APPLICATION ONLY BUILDING: TYPE'CON'ST.. / OCC. GRP.. A.P. Number 7 / 7 066 " Ol t Zip Lo 7 BGk rao� ZI al�G� Tel��_ 7C) Legal Description /1 ^ A _ ✓ �� Project Description Address I Statesit. �� / ( City & Clasi. 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,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 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). f: 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, 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. 11, 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, 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(e) licensed pursuant to the Contractor's License Law.) 17 I am exempt under Sec. B. 8 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 Cl 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.) 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. 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. CONSTRUCTION LENDING AGENCY Ihereby 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 WHITE = BUILDING DEPARTMENT Sq. Ft. Size New ❑ No. No. Dw. Add O Alter O Repair ❑ Demolition ❑ PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback rom Center Line Rear Setback f -om Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date* Permit Validated by: Validation: YELLOW = APPLICANT PINK.= FINANCE. ` CERTIFICATE OF COMPLIANCE �Fl�sc a Desert Sands Unified School -District 47950 Dune � Palms Road Date 5/22/03 � BERMUDA DUNES 0 • La Quints CA 92253 Cn RANCHO MIRAGE d {� INDIAN WELLS �. No. 24452 (760) 771-8515 qt.( �PAILLMuuESEI y I - VQ INDIO Owner Thomas Buffin . APN # 774-063-019 'Address P. O. Box 134 - Jurisdiction La Quints City La Quinta , Zip 92253 Permit # 034-273 ' M Tract # BLK 206 Study Area, i Type Single Family Residence No. of Units 1t Lot # No.�- • Street - S.F. Lot ,# No.. Street S.F.' Unit 1 =7 -53145, Avenida Villa' . . 1436. Unit 6 ` Unit 2 r Unit 7 Unit 3 Unit.8 - Unit 4 Unit 9 Unit 5 . n Unit 10 - Comments - .. 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 th D 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 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 - David Addington Check No. 281-200 • Name on the check Telephone 760/408-7528 `• Funding Residential By Dr. Doris Wilson v Superintendent >< y r - Fee collected /ezempt'd by Sh1piNn McGilv`y $3,07304 0.00 - Payment Recd Over/Under Signature /� ; IJ 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:VThis Document NOT VALID if Duplicated, R Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Gopy- Accounting :�_Z RECORDING REQUESTED BY: f Fidelity National Title Company P_ 'Escrow No. 46213 -CB Title Order No. 822757 When RecordedMail. Document and Tax. Statement To: William. Thomas Buffin P.O. Box 134. La Quinta, CA 92253 APN: 7-74-063-0.1-k= - - - - - WA - ; I FOR RECORDER'S USE , -= A The undersigned. grantor(s) declare(s) Documentary transfer. tax is 3 City Transfer Tax is $ [ ] computed on full value of property.conveyed, or [ . ] computed on 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, Contempory 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 tome on the basis of satisfactory eviderice) 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/herhheir signature(s) on the instrument -the' ®,��� .�0 person(s), or the entity .upon behalf of which the g person(s) acted, executed the instrument.' Witness my hand and official seal. Signature MAIL TAX STATEMENTS AS DIRECTED ABOVE FD -213 (Rev 7196) GRANT DEED,' RC:DISTRICT . PLANNING REVIEW FOP.M This form is, 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 toJile'for Master Design Guidelines. If the applicant does need to file's :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: ' APN 7 % `_: 6 3 Ol CASE ,NO.: LEGAL: LOT BLOCK oO (p UNIT ' S.C.4@V.L.Q. ' CHECK ANDAPPROVED BY.,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 COMMENT/CORRECTION Verify legal and APN information Consistent with MDG .on file (as applicable) MDG filing -required (5 filings since 913/98). pa< OCT -06-2003 06:21 AM I F Proj t Addr ss Ul Bu�r.Cont ct Telephone P.02 TESTING CF -4R Oat d�/ �✓ r2 7&n L� Builder Name Plan Number ;rttfymg R star T llep one Sample Group Number II IMb )- Signature /oafs Sample House Number Firm: SC.-L�SS'pGiQfgS' - HERSProvider.G.�S:oG/%%GS Street Address: A-WLSid CyGLs, City/State/Zip: zo ocr,►r Gs�' 9�2✓ 3 Copies to: Builder, HERS Provider HERS RATER O P I T T E T The house was: Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and Held verifleation, I certify that the houses identified on this form coyDisvioution y with the diagnostic tested compliance requirements as checked on this form. system is fully ducted (i.e., does not use building cavities as plenums or platform returns in lieu �f duCtS) r0 Where cloth backed, rubber adhesive duct tape Is Installed, mastic and drawbands are used in combination with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. } wQ 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 400efm/ton x number of tons enter . calculated value here If fan flow Is measured enter measured value here Leakage Percentage (100 x Test leakage/Fan Flow) = S, Check Box for Pass or Fall (Pass=6% or less) ❑ Pass Fail THERMOSTATIC EXPANSION VALVE tTXV) or Commission approved equivalent lLI Yes ❑ No Thermostatic Expansion Valve (or Commission approved equivalent) Is Installed and Access is provided for inspection �] Yes is a pass 13MINIMUM � Pass Faii REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1 0 Yes Q No ACCA Manual D Design requirements have been met (rater has verified that actual Installation matches values in CF -1R and design on plan. ^ 2. O Yes ❑ No TXV Is Installed or Fan flow has been verified. If no TXV, 14/4 verified fan flow matches design from CF -11R. • Measured Fan Flow = • Yes for both 1 and 2 is a Pass Pass Fail X. • 7 C Certificatoof 06cupancy 0 1782 OF'T19 Building & Safety, Department . This Certificate is issued pursuant to the requirements of Section 109 of the California • Building Code,, certifying that, at the time of ,issuance, this 'structure was in compliance with the provisions of the Building Code and the . various, ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 53-145 Avenida Villa ,:Use classification: Single Family Dwelling Building Permit No.: 0304-269 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC Owner of -Building: Thomas Buffin 1 Address: P.O. Box 134 " City, ST,;ZIP: La Quinta, CA 92253 By: Daniel P. Crawford Jr. Date` 10/14/03 - Building Official POST IN A CONSPICUOUS PLACE !