0301-180 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing wiih 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
V3 Ito
,✓Da l 7l J Signature of Contractor.x�?�
�r
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. 04�iBysinggA Professionals Code).
owner of the p opey,, am exclusivrelgJcontracting with licensed
,contractors�o/corfstru e6l prof ct (Sec. 7044',�Business & Professionals
Code).J� ,1, t' /� % ' c �t f
( )''I am exe pt under,Section B&P.C.,for this reason r
7'
Date 01") '�`.: ignature) of' Owner J
)_ 1Ly
RkER'SrCOMPENSATION DECLARATION
I hereby a ii�u dere�nllty perjury one of he following declarations!
O I hav lad h ma�• ta ( tificate of const to self -insure for workers'
A' Section 3700 /of the Labor Code, for thecompensate . n, as'pro�iidefot
performance of the work for which this permit is issued. r
( ) I have:and will mainiain workers',mpensation insurance, as required
" by
Section 3700 of the Labor4j�Code, for the performance of the work for which this'—''-'
permit is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier SUTR ;F"D - ' Policy No. 2�. oolm -2I,
(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 ')' -. 21
Warning: Failure to secure Workers' Compensation coverage is' nlawful 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.
.Y1: 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 authd'rizal representatives of this City to enter upon
the above-mentioned properrty' for inspection purposes.
Signature (Owner/Agent) ./Q Dau
PERMIT�#i^� _ ;4
BUILDING
.PERMIT
DATE : ALUATION , .jP�j� :j LOT - TRACT
JOB SITE
ADDRESS .'��c"iL�S yr
APN
OWNER "'
CONTRACTOR/DESIGNER / EN (NEER
LiAVID L A, 3101(frO24
RO, BOX 134 fj
41.780 RIKRMVx ,Q- E DR
LA Q13-.111TA 92293
WE "iii, MA DUNF.H CA 922,01
,
(70q)4064528 CBLO V24
USE OF PERMIT• '• '.•r
`yu
1431 8,11. S ,3. PF"'IT ' • . 1`1 p. IiffC2 UOY, EW.- 3C "�1tA , POOL Ofd..
1x1 IBJ 7;t,YjAPP1tORCt�j 14%. I'1;�N,f':Ii1 CK f?Xt d3�.Dt1 TI0N I3E1TO
1 UI.'['1.Pt T y4'I?ANC W1 ?s6; ;R'w1. 14 TYP
CT CONSOUe T1011t rip
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COH�TPUCTIOW VIER 1.011-0M,418-000 mmq
PLAN € HF --CK P'�'tr•
FEEDEP081T 42W'60
MECHANICAL PEix!, 101-000-421-DOO fbS3.Sti '
a
RLECT'I1.IC 1, HPE, 101-000-420,,M--0 S10*X1
P1,.t1K1:t'I'NO 279r% 10'1--:t 00-419-00 3 131..2,T
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STRONG MOTION + � I, ; RESW 101-000-24) -(X, *
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PIRECI'•°1± }='LAH 141-000-441:=345 Sigt3.g0 '
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$3, r 3 .73
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RECEIPT
DATE„P �,•'
r JJk
BYE”'
DATE FINALED CITINSPE
R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
923
Underground Ducts
_7_/&
Forms & Footings
. l _07
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
_
/
' �Ci
Exhaust Fans
F.A.U.
Framing
Insulation
/ –1-2.0 3 S
el3 _4874_
Compressor
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 APPROVALS
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
�Z iU3 ��—
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
Utility Notice (Perm)
COMMENTS:
Date
2/26/03
No.
24184
Owner
Thomas Buffin
Address
P.O.Box 124
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
q�J�Ft�sc�o
z o
BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS
PALM DESERT y
LA 0UINTA
�INDIO
O Y
774-123-015
La Quinta
0301-180
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 53555 Avenida Herrera 1431 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 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 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 $2.14 X 1,431 S.F. or $3,062.34 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. 278120
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exemptel by Sharon McGilvrey $3,062.34
e , Payment Recd Over/Under
Signature
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 Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
P-02
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R
Prp act Title Date �
Prpje Address —� BOW Name
L"
!
Budde• Cant t Telephone Plan Number
��ma.l�✓ ��57Z 3
HERS Rater - Telephone Sample Group Number T
ifying Signature D to Sample House Number
Firm:.T -C. d� ,�SfOG P S _ HERS Provider: J-6 -F XS�DI.,l�i�r1
Street Address' Cm,(� City/state/Zip: L41 Qglnr G'�' 9Z27,5'3
Cepies to: Builder, HERS Provider
HERS RATER COMPLIANCE STAT ME T
The house was; ArTested ❑ Approved. as part of sample testing, but was not tested
As the HERS rater providingdiagnostic testing and field verification, I certify that the houses identified on this form
comply with the diagnostic ested 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
°f ducts)
-610W,
cloth backed, rubber adhesive duct tape is installed, mastic and drawbands are used in combination
with cloth backed, rubber adhesive duct tape to seal leeks at duct connections,
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maximum 6% duct Leakage)
Measured
Duct Pressurization Test Resuits (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
—70
Leakage Percentage (100 x Test Leakage/Fan Flow) = / 1,0 y
Check Box for Pass or Fail (Pass=6% or less) ,L1 ❑
'Pass Fail
_a THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
Yes CJ No Thermostatic Expansion Valve (or Commission approved
v equivalent) is installed and Access Is provided for inspection ❑
Yes is a pass Pass Fail
Q MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
t 0 Yes ❑ No RCCA Manual 0 Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan,
2. ❑ Yes O No TXV is Installed or Fan flow has been verified. if no TXV,
verified fan flow matches design from Cr' -1 R,
Measured Fan Flow =
0 !�
Yes for both 1 and 2 is a Pass Pass Fa;l
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: SINGLE FAMILY DWELLING
53-555 AVENIDA HERRERA
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: THOMAS BUFFIN
Building Official
Bldg. Permit No.: 0301-180
Land Use Zone: RC
Address:
P.O. BOX 134
City:
LA QUINTA, CA 92253
By:
KIRK KIRKLAND
Date: JULY 18, 2003
POST IN A CONSPICUOUS PLACE