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0307-017 (SFD)On H N U) W O � � LLI o Z O O W w I— a U) Z co LO N O� U Q CL — r Q 0 0 J J mVU O d rn ItZ Cb Z) �d J 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 682901 // � 121311'2( -i Dat �� Signature of Contractort1 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, Busine�s & f ssionals Code ( ) I, as. ownerrof'therty, "prope.am exclusively contracting with licensed contractors to construct the .,eject (Sec. 704Business & Professionals Code). ? �� () 22 I am exempt under 'Section� B&P.C.-for this reason Date Signatyre of Owner WORKER'S COMPENSATION DECLARATION //r I hereby affirm under pe nalf�ofl(perjury one of he following declarations: () I have and will`mainta'inf`H&_prtificate of conser.1t to self -insure for workers' compensation, as provided for b�-Section 3700�f the Labor Code, for the performance of the work for which this permit is iss/u'ed. ( ) 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, STATL FUND Policy No. 229- 001.97P.2603 (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.Jaws 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 those4pr visions. Date: Applicant r s•��`� "" 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 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) , f Date—> > ej3 �r BUILDING PERMIT PERMIT# DATE_` VALUATION LOT WV7-017 TRACT Il $p7,125M 5 JOB SITE ADDRESS. 53-&5 .A.`1ENDDA .IF N' . �. APN 774-1.23-017 OWNER' CONTRACTOR / DESIGNER / ENGINEER 'B101AAS A8 BU PFW DAVM 1... f.tl?D1N'OTON P.O. }3f)X 134 41 7$0 HMN1.rQAC + 1YR Lie QMNTA 922.33 BNT.tA9TJ.0 A D13.M CA 92201 (760)408-7528 CBL* 3724 ,.� USE OF PERMIT 31NCaf1.lE FAN LY DWF MC+ 14ING :I,F' SM PERMIT DGM NO°T INCX�U )E HLOCK'WALI, P0OI.fS:PA OP. t• DRIV'EWAYAPPROAChi 0 TRACT CON'1'I'6CTION 1,408-0.0 SF i';)RCH/PATTO ' 36.00 SP GARA.G1;.lCARPORT S ,00 3F ESITA',1 A'T.) C'OS'f or Co11ia!1'CdC;'Tl~olY P`YRKC'f Vwx 8'(WMA)Zy CONSTR.UC:TION PRE 101-000.418.00-0 $385.50 PLAN C:H;T, K FrlN 101-000439-318 $464.80 FEE DEPOSIT 101-000-439-316 4230.00 MECHANICAL 1of?P, 101-000.421-000 $51.0 BLECTR1CSAL FEE 101-000°4^x0000 S108118 PLClMF311y'CY FEE 101-000-419-000 $17,,11.00 131TRCiNG MOTION FEE • P. SID 101-000-241.000 Sell �1?�Dnac� �� 101-Ocxa-4��-Qt�� aI9.00 DEVELOPER IMPACT FEE 52,4Q5.00 PRECISE PLAN 101-000-441-345 �100.flfi 110N1i1"kl'UCnION A m PIAN CDECK 6:3,888.69 o D i s PRE,-1?AM FmIll -$250.00 JUL .16 2003 T(I-AL p ,l+, cT.Ieff's DDR X0.W CITY OF LA QUINTA FINANCE DEPT. RECEIPT - DATE /� BY ! DAJEINALED O ]INSPECTOR. 1� 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 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 - �G �- 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 a Encapsulation .Gas Piping Gas Test Appliances ` Final Final Utility Notice (Gas) ELECTRICAL OPROVALS 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: Building Address T4tyl " P.O. BOX 1504 APPLICATION ONLY 78-495 CALLE TAMPICO Al) LA QUINTA, CALIFORNIA 92253 owner , ho ,� Mailing Address /' Tel. Contractor AGGress q/ 1(�0 �ln�� I A Tel. State Lic. CSfQ 9a, City 8 Classif. Lic. # Designer Address CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under Drovislons 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,Buslness and Professions Code: Any city or county which requires a permit to construct, atter, improve, demolish, or repair any structure, prior to Its issuance also requires the applicant for such permit to rile 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). 12 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 ownerbuilder will have the burden of proving that he did not build or improve for the purpose of sale.) I'1 I, asowner of the property, am exclusively contracting with licensed contractors to con- struct the project. (See. 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 (l Copy is filed with the city. O 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 thq 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, alter making this Certificate of Exemption you should become 1 subjectto 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 slate 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 a0plicant Date Mailing Address City, State, Zip LDING: TYPE'CONST., OCC. GRP. ' Number �y— �O� 3 —D 7 Legal Description Project Description S 14�0 Sq. Ft. / No. No. Dw. Size �O (�' Stories Units New ❑ Add 0 Alter ❑ Repair ❑ Demolition 0 Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. �Qp Plan Chk. Bal. Const. Mech. Electrical - Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line FINAL DATE Side Setback from Property Line INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 4��o 47950 Dune Palms Road ¢ gERMUDAOUNES O La Quints, CA 92253 � RANCHOMIRAGE Date 7/10/03 a INDIAN WELLS No. 24696 (760) 771-8515 ��"?"��P LA QUINTA COALM DESEM �+,J�INDIO^� vv O J Owner Thomas Buffin Address P O Box 134 City La Quinta Zip 92253 APN # 774-123-017 Jurisdiction La Quinta Permit # 0307-017 Tract # Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 5 53595 Avenida Herrera Unit 2 Unit 3 Unit 4 Unit 5 Comments 1408 Unit 6 Unit 7 Unit 8 Unit 9 Unit 10 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 $2.14X 1,408 S.F. or $3,013.12 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 PC/Valley Independent Bank - David Addington Check No. 287315 Name on the check Telephone By Dr. Doris Wilson Superintendent Fee collected Signature Funding Residential Payment Recd $3,013.12 Over/Under NOTICE: Pursuant to Government Code Section 66020(d)(1), this w11f svdre 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: This Document NOT VALID if Duplicated Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting JAN -23-2004 06:10 API. �1 .CERTIFI prnioM-THIO P.01 TESTING CF -4R Dat Builder Name Plan Number Semple Group Number Sample House Number . Firm:HERS Provider TG.NL&gr Gf rS _�r�r �Ay f�fd In u Street Address %��(J GYGL¢� City/State21p: z1 Cd ` ZIO Copies to- Builder, HERS Provider HERS RATER QQMCLIANCE STATEM2LT The house was: ATested ❑ Approved as part of sample testing, but was not tested As the HERS rater providing diagnostic testing and riald verification, I certify that the houses identified on this form coV ly with the diagnostic tested compliance requirements as checked on this form. Distribution system is fully'ducted (i.e., does not use bulldirig 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. MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 6% Duct Leakage) Measured Duct Pressurization Test Results (CFM Q 25 Pa) values Test Leakage Flow In CFM If fan flow is calculated as 400cfm/ton x number of tons enter value here calculated If fan flow is measured enter measured value here ay !�-' :� Leakage Percentage (100 x Test Leakage/Fan Flow) =. Check Box for Pass or Fall (Pass -6% or less) ❑ 8s5 Feil ,' LW THERMOSTATIC E=XPANSION VALVE (TXV) or Commission approved equivalent pf'-Yes ❑ No Thermostatic Expansion Valve (or Commission approved �^ _ equivalent) is Installed and Access Is provided for inspeotion ❑ Yes Is a pass ass Feil ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT • O Yes 0 No RCCA 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 0 No TXV Is Installed or Fan flow has been verified, If no TXV, verified fan flow matches design from CF -1R. Measured Fan Flow D ❑ Yes for both 1 and 2 is a Pass Pass Fail y r � ■ ■ �0a a'•c - Certificate of Occupancy0 0 Tiff 4 Building & Safet D ment OF g y 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 f provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. k 9 BUILDING ADDRESS: 53-595 AVENIDA HERRERA ` ' Use classification: SFD Building Permit No.: 0307-017 d j Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC a y G z Owner of Building: THOMAS BUFFIN Address: P.O. BOX 134 City, ST, ZIP: LA QUINTA CA 92253 e By: KIRK KIRKLAND z ham Date: 1-27-2004 Building Official POST IN A CONSPICUOUS PLACE