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0201-128 (SFD)LICENSED CONTRACTOR DECLARATION ' .,Vhereby affirm under penalty of perjury that I am licensed under provisions of I--: Chapter 9 (commencing with Section 7000) of Division 3 of the Business and cN'w Professionals Code, and my License is in full force and effect. 0 Q C) License # Lic. Class - `� Exp. Date oZ Date ld r' h7, Signature of Cont ac J U co OWNER -BUILDER DECLARATION HW I hereby affirm under penalty of perjury that I am exempt from the Contractor's co License Law for the following reason: Z_ ( ) I, as owner of the property, or my employees with wages' -ad 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). C0 O I am exempt under Section B&P.•C. for this reason LO N Date Signature of Owner, ` ON CL Z WORKER'S COMPENSATION DECLARATION 'IT CD tr I hereby affirm under penalty of perjury„one of the following declarations: U') H O () 1 have and will maintain a certificate of consent to self -insure for workers' X W compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q.0 ( ) I have and will maintain workers' compensation insurance, as required by . O Section 3700 of the Labor Code, for the performance of the work for which- this Il L1 Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carriers Policy No. ob 5 n d J (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 and agree that if I ;should become subject to the workers' compensation provisions California,`of Seecti n' 3700 of the Labor Code, I6s/hall forthwith comply with those provisions... Date: ! ! �� d .l � .Applicant , - • � .,.� ' 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. Y 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) ms's^'` `-�- '' Datel ,,,e � G BUILDING PERMIT PERMIT# 0203-128 DATE VALUATION LOT TRACT JOB SITE APN ADDRESS 51- M ATUT . A 1 glR9114 OWNER CONTRACTOR / DESIGNER / EN (NEER 1XIM 8�U.i'.FX/_kA= BRAT CIOAA BRAUC5.i° .W .fir°. PO BOA' P y F0 -t©'X 51 � 'A QUINTA CAa 921S- LA QY=1 1i CA, 0-^53 (760 •409-5422 MIA# 2387 . USE OF PERMIT �G S OU tAn? .y . 0iW{ r• S)1010 PE -RIMA',' D01M 140T MC,LUMe 13IX)CK WAl.. % POOL, CYR..1,1p1YY AI'PYtf3Aal-W.49TR k. T34 i T!.1ACT C 0N9TltLEO'1'10).4 1,49.2.00 V 0MAIRAIA, RRPORT 463.00 63F 3 YT, we"'Jd73:) naim!” 200.00 t XTUAINUM (1,10V Olt C;'t7�Vib+"YMIC3.7tDA CONSTRUCTION Int✓ 101 -0 0-41 B-000 $603.0a PLAT.v CH WK MEE X 01 ••00"39_3 k a WGHANICA1, na 101-000-421X000 $Aso if;1,,1si.MICA1• Y "I, 101-000-420r000 $13ff 08 PWIvIB IN ThEK 101 000 -419_000 419_000 14.30, AP STRO140 R8OTMN �� - REBID 1.01-000-241-000 V.30 C 44DINO FRE 'I13? 4Ca00Ad� 4-�f1f? $%i1,L'� PR.EC:IV PLAN 101 X000.441 -a4 S S10106 FEE Ia IPV4191 g I R) it000A39.318 •$a5Q.l1�i StipW'S.IiTO"tL 0.+L.7JESTW UA�J,. 0). AfVD i".i.rAN C3WXX *934006 L310, FREIPAIDMIKS 4,250.W Y. iATAL rmJ,i.59. IT" DV E AN OW YY tf+.j ge.0 , C6iY ®F LA0,U1n A ir DATE By DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs GfL— IgZrX Underground Ducts Forms & Footings Ducts Slab Grade tl Return Air Steel Combustion Air Roof Deck - / 0 7/ Exhaust Fans 0. K. to Wrap a L F.A.U. Framing %5, P Compressor Insulation Z -4o ol Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath - 5 -o S.T. Final Final _ BLOCKWALL A PROVALS 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 . 3— 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 Utility Notice (Perm) SG .S 6 Z - COMMENTS: ,: i.a,�,�y..„+.,rr'"`e 1 Y.,�..w,.,fr+'•-�'r+ i"vt�.,�.:�,�, 1,-.,:yr.,r,rr..:_ Bbl'•'r/"`,ygd�,`�•�.I-i'y+�y *;VT;, ` i:,:i�iw'"+"''JT+?'•'^1 �~1'i�"jd�!`� i O Zoe �lZ �iiV 1 P.O. BOX 1504 APPLICATION ONLY Address `c4'`�e �%V 11ol"'r� QUINT CALLE CALIFORNIATAMPIO r LA oUINTA, ORNIA 92253 ,w5� F4G�' Owner _ 1 j I fid' Mailitn ` ~ BUILDING: TYPE'CONST. OCC. GRP. r �/ Address A.P. Number / ^2 3 7r 2• o z? City ��*11 JZj� Tel._0�) i ct 2- z S �(� Legal Description L r �� �� _s_3 Contractor .3 2Q.Jc Iz u y I,{-C� Zlp�, L 7 ) 3 Tel. L r✓ �Y State Lic.' City & Classif. Lic. p Designer Address City IZip I State I Lic. If 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 lot 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 (8500). 1_ 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. 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 II' 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.) 1-1 1 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 (7 Copy is filed with the city. O Certified copy is hereby furnished. r CERTIFICATE OF EXEMPTION FROM { • WORKERS' COMPENSATION INSURANCE (This section need nol(be completed if the permit is for one hundred dollars ($100) valuation 'a1 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 1hereby 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 it 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 atfplicant Date Mailing Address City, State, Zip Project Description_ �2— Sq. Ft. No. Size Sto I IE� t,,e No. Dw. New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure; , _, it iii i nFr 2. it-�y1N TOTAL t5i5 Jr �": REMARKSC r,.'L�_"'_• 1l ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DAT INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION r Notice: Document Cannot Be Duplicated Date 1/18/02 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE APN# 773-132-023 No. 22844 Jurisdiction La Ouinta owner NameTom Buffin/ Mike Brauckmann No. 51-725 Street Avenida Herrera City La Quinta zip 92253 Tract # BLK 53 Lot # 11 Square Footage Type of Development Single Family Residence Comments Construction Permit # 0201-128 Log # Study Area 1492 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 2.05 X 1,492 or $ 3,058.60 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 CCNalley Independent Bank - Mike Brauckmann Telephone Name on the check K � By Dr. Doris Wilson Superintendent Fee collected /exempted by Nicola Wong Payment Received $3,058.60 �, Check No. 261932 Signature NOTICE: Pursuant to Assembly Bill 3081 (CHAP 549, SWS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting RECORDING REQUESTED BY; Ahu WHET: RI900RDED MAIL THIS DEED AND, UNLESS OTHERWsE SHOWN BELOW, MAIL TAX STATL1,AC-NTS TO; William Thomas Buffin Power Brokers B.0. Box 134 La Quinta, CA 92253 ......�., _.,M.._, ,......_ ...............:..........:.........._ _._...._...._:.._.......... ......... ..,........_ I COLMMONWEALTH TITLE 011002 SPACE ABOVE TH;S L ND FOR RECORDER'S USE ThA unders!gred grantors) dec)®rv(e): OtBflt Deed /4 P.N. 773-132,-023 Cocummnta,y !ransfar t®x is S /- 7D, �� ( x,� ccmauted on full vel'le of praperty conveyed, or ( �) compulea on full value less value of liens ani encLo-lbrances rernalnlrtg at timb of We. j Unincoraorated area; ( ) City- of FbR: A VALUABLE CONSIDERATION; reca)pt'of which Is hereby aeknowled;ed, K & S BUILDERS INC. 'hsarAby GRANT($) to WILLIAM TPOMAS BUFFIN, at utlmrried man the real property In thq Clly of ie Quanta : CO.Onty of Riverside State of Caiifornia, described as Lot �1�1 of Block 53 UriiC V4. —1 Santa Cartneltta at gainta, ae per map recorded in Book — Pages mf Maps, ReluQrdsl I County, California ti a- La of. Itiverr and viae CatesDecember 12, 2001 I ---r 1 ,�—. Signature o', Grantor State of Cel!crrlacauniy if ) _„ Oa- be!ore me, K&S BULLDERS INC. �m personale appeared - —� K BUILDERS" --_INC. I peraone•ly known to me (or proved to me on the basla of satisfactory . ev(dar.ev) to be the parsort(e) whose ramo(a) ;Blare aubscrlhad to the wlihi^ instruTtent and aok,We9ped to ma oat he/ehelthey exactttad the carne In his/herlthelr authorized oapacity(iea), and that by i htgJhorJthelr elgnature(a)_an the,.lsietrumen( the pemon(s), or the entity upon behalf of which (ha persori(s) amid, executad the inmru,rent, WITNESS ,rry hand and nrf[clat seal, Slpnature � ,: AtA.iL TRX STATMC-NTS TO � g a I. i 1,441 _.................._.,......._...•..,_...._................,...........,.,.•,............ _ .................. .......... 01/12;01 14:90 FAX 17606048062 COMMONWEALTH TITLE 009 RECORDING REQUESTED SY, P,ND WHEN RECOR]ED MAIL THIS 05 -ED AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS T0; Mr= & Mrs. Agustin Paz SPACE ABOVE THIS LINE FOR RECORDER'S US! Grant Deed A.P.N. 773-132-023 The undersigned grantor(a),declare(s): Documentary transfer tax is $ ( x) computed on full value of property-onvoyad, or t ; camputed en full value leas value of wens and encumbrances remaining at tuns of sale. ( ) Unincorporated ares: ( ) City of and FOR A VALUABLE CONSIDERATION, receipt of which Is hereby acknowledged, PAT BEGIN hereby GRANT($) to AGUSTIN PAZ and EVA PAZ, husband and wide as joint tenants the reel preparty in the City of La Quinta State of Onlifornia, described as : . , County of P.iverside Lot 1 fif Block 53 Unit: No. Santa .Carmelita at Valla La Quinta, as per map recorded in Book page® I of M8;pa,. records of Riverside County, California Dated' September 5, 2001 SignetireolGraantor State or Cal' rorniaa ) County of )8S. AT BEGIN — On _ --before me, personally appearrad PAT BEGIN: personally known to me (or proved to ms on the basis of satisfactory. - —m-�-- ----^- Evidence) to be the person(s) whose narns(s) Islare subscrlDed to tho `•' wilhtr, Instrument and acknowledged to me that he/she/they executed tho earns In hie/herhhelr authorized capacityoas), and that by 1116/herAMOIF aignAWN(II) on the Intulrurnent the person(®), or the entity upon behalf of which the person(s) acted, executed the Inst"Wriont. WITt,ASS i+ty harld and efflaal $Gal. Sipnelure MAIL TAX STATEMENTS TO, name aas a.1. l 'd I ZC W oN S8,3;ICH bdNOd YV ,6Z 11 ' 101)'c 1l 2'o SRN RC DISTRICT - PLANNING REVIEW FORM 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 house 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 transmitted this information to the Building and Safety Department as part of your correction list. Please attach additional explanations as necessary. APPLICANT BRAUCKMANN INC. SITE ADDRESS 51-725 Avenida Herrera APN 773 - 132 - 023 CASE NO.: 2001-60e LEGAL: LOT 11 BLOCK 53 UNIT S.C.@V.L.Q. CHECK AND APPROVED BY: WA l l y Nesbit 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 tl�AiFy e"-0eS2--tY Consistent with MDG on file (as applicable MDG filing required (5 filings since 9/3/98) Architectural variety within 200 feet.of the surrounding area: _ Lo Lv✓c S 7� �S � N�- Scr.",I Ri f -Vt 77--'-6- Colors Materials Architectural design features Approved by' Other Requirements: [3 Planning Commiss on eso ---- O City Council - . ommunity Dev. Dept. Initials Case No. c Z ----- _ Exhibit 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: SINGLE FAMILY DWELLING 51-725 AVENIDA HERRERA R-3 Type of Construction: VN Owner of Building: TOM BUFFIN/MIKE BRAUCKMANN Building Official Bldg. Permit No.: 0201-128 Land Use Zone: RC Address: P.O. BOX 517 City: LA QUINTA, CA 92253 By: RICHARD KIRKLAND Date: 06-03-02 POST IN A CONSPICUOUS PLACE CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING • GZ� Project Title`/ Da re Pmiect Address Builder Name Buflder Cont t Telephone C�%ham . 2,/ 1 57 -3 HERO Rater _ Telephone Plan Number Sample Group Number Ortifying Signature Date Sample House Number Firm: �� 2 �)�,/��/�� // HERS Provider: �L' ¢ S d Z_ 7EZXV /l/6mW� 4r44 cit �jm / Street Address; y/State/Zip: � �i� /�.S Copies to: Builder, HERS Provider CF -4R l HERS RATER COMPLIANCE STATEMENT The house was: Tested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form co ly with 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 with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. 9 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 400cfm/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) Check Box for Pass or Fail (Pass=6% or less) �' ❑ Pass Fail 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 ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. ❑ Yes ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual installation matches values in CF -1 R and design on plan. 2. ❑ Yes ❑ 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 = Cl ❑ Yes for both 1 and 2 is a Pass Pass Fail