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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
920 81 03110 r'tn
Date ' -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 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.
( r I have and will maintain workers' compensation insurance, as required by
Stiction 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 8.1,Xrj VNI) Policy No. J51164 2- 1
(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: Applicants I
Warning: Failure to secure Worke(s' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and*civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety-
for a permit subject to the conditions and restrictions set forth on hist:;
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize,.representatives of this City to enter upon
the above-mentioned property -for -inspection purposes.
Signature (Owner/Agent)/ Dateiv'/y t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT��'�� TRACT
0"M00.1 '40.70 14LX_ 14 Ell
JOB SITE
ADDRESS 77-4*CA IARKS.MADA
APN
773—""13
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
bWILIJAM 'RUFFM
CON".! AA�f__b13RAR Y Hii2a S
WX 1141
51370.013M)A RPRMODAS,
1A Q T.MJ.TA, d'",.a 52 3
LA QI;.fTx TrA, CA 92253
(760)564-1%2 M-4 6255
USE OF PERMIT
+f3WEX FA1i$.� `� DWRLUNG
b'F+V1'AM]!''�" r :DCVI nxworl. BLOCK muz a, PCJtK, Uig. DvrawAy
ANYROAC
Imiza V111/11111c) 141.01511 SY
AR,ACIRCARPORT 49100 M?
HAP UP= FUR 101-400-439-318
r IVT M- i3"%P4- 12
MUCHAMCALF9I1 191-100-421-W $105.00
MITJ.irvkM"ro.1M3 1181-000-4194Jt, $16S.So
S1RONGM0700 M . MUD 101-000-2.41-0 U3.63
GRA3�.tn 0 FBF 01.000 73a+w 3130
Mcm PLAN 101-Csa<0.141-343 $10 00
SUB-'1TOTA1,, AM) PLM GURCY.
W.0,69.75
MAY a 91802 LEBO RRA-YAT]a MYS
4250M
CITYOFLAQUINT 'rFJ:LWf .%DURNfYW
$3,019.75
FINANCEDEPT
RECEIPT DATE n BY DAT FINALED INSPECTOR
"`� .".
7 : L L. (!/1
/mss,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
yp`0,Return
Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
lj
Exhaust Fans
F.A.U.
Framing
i d
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
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
-ca (
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:
f
Final O
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power p
Final
Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated
Date 5/9/02
No. 23203
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Jurisdiction
Owner NameTom Buffin
N0.77440 Street Calle Ensenada
city La Quinta Zip 92253
Tract # Lot #
Type of Development Single Family Residence
Comments
APN # 773-284-013
Permit #
Log #
Study. Area
Square Footage 2302
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 the amount of
2.14 X 2,302 or $ 4,926.28 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 Union Bank - Mark Kellog Telephone
Name on the check
By Dr. Doris Wilson
Superintendent -
Fee collected /exempted by Crystal Scott Payment Received 44,926.28
Check No. 7689063
Signature
IOTICE: Pursuant to Assembly 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
bove 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
ollect 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
xavier urbina
4986 paseo segovia
August 17, 2002
City Of La Quinta
Dept. of Building and Safety
78495 Calle Tampico
La Quinta, CA 92253
Project: Plan Tucson
77440 Calle Ensenada
Re: Field Visit Of Construction Site
architect
rvine, calif. 9
(949) 856-0706
Gentlemen,
The following structural discrepancies were found at the site visit on 8/16/02:
1. Some truss ends, where trusses are perpendicular to wall, were found to be
unsupported laterally at the bearing wall. Particle board or plywood across the
p*,pf ttie trusses, or'x' bracing between the trusses from top to bottom chords
just adjacent to supporting wall, may be applied to keep the trusses from racking
in the event of seismic activity.
2. Several 'x' braces in the interior of the Living Room span were found to be
missing. `X' braces need to be added between the trusses at these locations.
3. A top plate in the corner bedroom was bored for the purpose of installing a gas
line in the wall. This will be remedied by adding a Simpson 'FHA 9' strap across
the pipe opening on the inside face of the top plate.
No other discrepancies were observed during the field visit. All framing hardware and
nailing appeared to be in good order. The correct plywood shear panels were installed
everywhere. Foundation anchor bolts were all in place and proper spacing.
Please feel free to call if you have any questions.
R pectfully,
avier Urbma J
Architect
00'"-
`Y41511
INO: C- 33
xavier urbina architect
86 paseo segovia Irvine, ca
April 20, 2002
City Of La Quinta
Dept. of Building and Safety
78495 Calle Tampico
La Quinta, CA 92253
Project: Plan Tucson
77440 Calle Ensenada
Re: Truss Calculation Review
Gentlemen,
A copy of the truss calculations- has been submitted for review. The package
consists of truss engineering calculations, truss configurations, and truss layout.
The manufacturer is listed as Trussworks of Thousand Palms, Calif. The truss
design and layout are in conformance with the structural design and intent of the
structural drawings and calculations.
Please feel free to call if you have any questions
R spectfully,
avier Urbina
Architect C13,333
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: SFD
Occupancy Group: R3
77-440 CALLE ENSANADA
Type of Construction: VN
Owner of Building: WILLIAM BUFFIN
Building Officia
Bldg. Permit No.: 0111-117
Land Use Zone: RC
Address:
PO BOX 1141
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
2-6-03
POST IN A CONSPICUOUS PLACE