0306-006 (SFD)f
LICENSED CONTRACTOR DECLARATION
Lt! 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 # Lie. Class Exp. Date
f� fi i!M1
,Date451 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.
`IQ) 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 371,x*E FU)41) Policy No. 2:4v- 0010787-300
(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 f
Date: Applicant—1 / —7 �7 �•-�
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 fo�in`spection pyrposes.
Signature (Owner/Agent) J X1 r /�--- t -• Date
rte..,. ,�_.-• � �- .
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
ALX 66
JOB SITE
APN
ADDRESS 77„,5$0 CALIX:�IiAY.00
773x-C-83AYM
OWNER
CONTRACTOR / DESIGNER / EN INEER
THt)A&N3 BUMN
DAM L. AiJJMITCMN
k,Os '.1 ?A
4♦1•n”iT#.��C�+7.YKERur�>�{11:.�Y!+sTE 1)13.
pA, A �nq
,�.,fA 2w,.kcd J3 l.':7D rJ12-�3
�yp f
e� 921201
BTQT 1A .1S.AZ1t1Y.L'�aJ CA 921:201
C?t50j40s-':1528 Off1h 3724
USE OF PERMIT
i33?3C jsW, I+.tl1:L`' �rE+1.1', tbc3
tStd .k' CF)i F9f?.MIT 1~It.�L3A1QT YNC1;MOCK OCFK,' WALL,1'C�kf7l.0
OltIti;•��A.'Y'.A�sr'.�OA(:�?5�e R�I31JIrJ�.I3 Ir�;ci Clag+vi;..1�GE �'l7li IVitiLTifi'i.T?
PLANS s;)1t :x/ 14M 'TY'PE
TP_hCT CONSTRUC710N 1, 14.0 ; F
-C+1FCM41ATIO ? 176.i10 SI:
OARA.IVCAPTIORT S34141 OF
I-Sr,C "TETE-J MUM OF #5ONS)i'.f�UC170:AT
;1 i `r�A+ Via' PRE sr, MrA'A1 `d'
CONZ7:►RUC (614 M' 101.0(110 418-c)rr;.1 4021,30
PILA.'1dCHEC K.. irVl 101-000-439-318 113,X9.51
FEZ DEPOSIT 10 I •t 00.4394;4 I s, 411150100
'
M?,C:f ANIC.Jt t'. FE`% 101.600-421-000 *52.50
ElIIECTA4CA)I Y&S. 101-000.420.OW f.d 12, 11
P:LIJA:4VINCI ME 101 _000-419-.600 t130.Gt7
OTROWI hf.0,a 1;),:g -It-EE. I Iii#145 101.0('A0-241.OW3 40,51
GRA57MPFIrl 01. 21;1341.X42',-1141{1 $15,00
PRMSEPd AJ 1014.*Gi441-34 ji,6li9.f)0
M—rit-10T:A.:t., (>CS.N 'iF+:;:s7[<<);�1'.F,�+71a k?t;:�1;+1'Cfl vl:
$3,575.23
DA
TOTAL :"'EMM JITMS DiX AM
JUN 18 2003 `
CITY OF LA IQUINTA
FINANCE DEPT.
RECEIPT
DATE
BYD
TE FINALED
INSPECTOR
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
O
Exhaust Fans
O.K. to Wrap
— Q
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
z'(
Final
Final - O
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
I I
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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole —ol
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
0
.moi
D3 4-1`1111 "
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
J0 CO, L J C— %fWA, LA OUINTA, CALIFORNIA 92253
sJfl ly h w 4-S' o
Mailing n
Address P.
City t Zip Tel.
L �-
Contractor
VI % ® 1
ou LI�
AMOUNT
lel. 4 _
State Lic.
Plan Chk. Bal.
City
& Classif.
Mech.
Lic. #
Arch., Engr.,
Plumbing
_
Designer
Grading
Address
Driveway Enc.
Tel.
City IZip 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) or
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 (5500).
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 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 or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensedpursuant to the Contractor's License Law.)
11 1 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
fl 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 (S 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
I hereby 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 1 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
LDING: TYPE�'fCONST. J OCC. GRP. R J
. Number 7,73 3 - o 83 • o.2 "1
al Description tern I,. 8(K to A)
ject Description
Im
- _-IP o X05.1
Sq. Ft. �t r�^No. / No. Dw.
Size > Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
_
Grading
7�7
Driveway Enc.
Infrastructure
11 MAY
L - �oip 11 U11
1-1
TOTAL
REMARKS
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 DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE
Comments
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 1,514 S.F. or $3,239.96 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. 287275
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Shargp McGilvrey $3,239.96 5
,, • ///e A I 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 District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant 'Copy - Applicant/Receipt Copy - Accounting
MAY -05.2003 MON 19:29 AM
Date:
-7V;bO 4AUC- 111 DAL (,o
FAX NO, P. 04
C V
gmtfty of cunum
STEW ART TY'I'LE OF CALEFORNIA, INC.
Inland ftplre Muton - Escrow Services
44354 Monterey Avenue, Pulm Dnel t, CA 92260
060) 9631874 Fax: (764) 56&5479 www.WWes.com
Escrow Officer :' LILIA SUTTON
Escrow Number
Property Addresst
SUPPLEMENTAL ESCROW INSTRUCTIONS
9MWART TITLE OF CALMORMA, INC. IS LICENSED BY THE STATE
OF CALIFORNIA UNDER TRE DEPARTMENT O?' INSURANCE LICENSE NO. 386.
In accordance with the provioions of that certain Residential
Purchase Agreement cmd Joint Escrow Instructions, (herein after
referred to as the Agreement), dated TO FOLLOW., by and between
GHOLAMHOSSEIN M. BIGDELI AND REHAM A. KBIYARIY as Seller(a), and
POWER FINANCE ASSOCIATES INC as Buyer(s),
PARCEL NUMBFt _:713-0:8.3-.024
LOT Kl`Z,;HLO:CK""66., J SANTA CARMELITA VALE TRACT, IN THE CITY OF LA
r `"QLYINTACOUIITYF RIVERSIDE, - STATE OF CALIFORNIA AS PER MAP
RECORDED IN BOOK 1.8, PAGE 67 OF MAPS IN THE OFFICE OF THE
COUNTY RECORDER OF SAID RIVERSIDE COUNTY CALIFORNIA.
Escrow Holder acknowledges receipE of a fully executed copy of
Agreement, counter offer numbers 0, and agrees to act as Escrow
Holder as described in Paragraph 28 of the Agreement and
subject to the terms of Escrow Holder's instructions herein,
and General.Provislons. All other sections and/or paragraphs of
the Agreement are matters between Buyer and Seller in which
Escrow Holder ohall have no concern and/or liability.
The following are hereby added to the agreement for
clarification purposes only and the parties hereto agree to be
bound by same as far as the escrow is concerned. The intent of
the following instructions are not to modify the agreement,
only clarify Escrow Holder's duties thereunder.
SECTION I
1.. The undersigned will hand Stewart Title of California, Inc.,
Continued on next page
V A BtZ9'ON N133H NVIl11M R60 -Z1
RC DISTRICT - PLANNING REVIEW FORM
k
This form is to be used by CDD staff for review of single-family dwellings in thea 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.to file for Master
Design Guidelines. If the applicant does need to file a 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 ADDRE:
APN Q8;3 - oa &1 CASE NO.: 7
LLOT\ oZ. BLOCK tD UNIT S.C.@V.L.Q.
CHECK D APPR ED BY: DATE:
e assign d Building plan Checker upon your assignment to this case. The CDD
Executive Socre ry 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)
1*0
MDG filing required (5 filings
since 9/3/98)
es,o #
Architectural variety within 200'
feet of the surrounding area:
Architectural design feat r s
oven
9•
eP�.
�
ov
�t\1e
Gay�10
�o
n5
Other Requirements:
G
AV%
DEC -04-2003 09:33 AM
TIFICA
! Title
i Address
a
Ater
Elullder Name
Plan Number
Sample Group Number
P.01
CF -4K
,ifying Signature D e Sample House Number
Firm: Wil. -4- HERS Provider: Te"� hS5-0C6j%S
Street Address! 7,yl�a/a r✓ rG1�v City/State/Zip: Zy 0t{/hfa-
Copies to: Builder, HERS Provider
HERS RATER CQMP61ANCE STATEMM
The house was: it 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
Com y 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 drawbancls are used in combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
4�rMINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing Results (Maxirnum 6% Duct leakage)
Measured
Duct Pressurization Test Results (CFM (M 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)
ass Fail
THERMOSTATIC E;
SION VALVE (TXV) or Commission a
valent
Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) Is installed and Access Is provided for inspection
Yes Is a pass
❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. D Yes ❑ No ACCA 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 ❑ No TXV is installed or Fan flow hes been verified. If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
Pass Fail
Q ❑
Pass Fay!
Certificate of Occupancy
I.ma�anzsn��
G
OF Building Y p & 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: 77-580 CALLE HIDALGO
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0306-006
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: THOMAS BUFFIN Address: P.O. BOX 134
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
Date: December 18, 2003
Building Official
POST IN A CONSPICUOUS PLACE
JUL 21 '03 15:29 FR
rr 7pIn O" W' n
eToBuzld 4n
Engineering - Consulting . Testing
TO 9-7777011 P.03i07
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: DAVE ATTINGTON PROJECT: 77560 AVE HILDAGO
POWER FINANCE LA QUINTA, CA
PO BOX 134
LA QUINTA, CA 92253
DATE: July 14, 2003 OUR REPORT Nth.: 073-30282-2
TEST DATA: (1) Fine to medium grained sand. OPT. MOIST. = 12.0k
—
TEST
NO.
-- --7--•-------
TEST
DEPTH
ELEVATION
---
SOIL ID
NUMBER
--'MAXIMUM
LAB DRY *
DENSITY
-----
WATER
CONTENT
_
1
_ –
8"
FG
1
118.5
9.7
2
8"
811
FG
FG
1
1
118.5
118.5
10.1
3
10.4
4
8'I
FG
I
-- --
1
118.5
10.1
I
-...... ---------
TEST LOCATION: House pad -- 77580 Ave Hidalgo
1 Nw Corner
2 Sw corner
3 SE corner
4 NE corner
COMMENTS'
WET DRY PERCENT Spec. 90& .Min
DENSITY DENSITY COMPACTION
125.5 114.4 96.5 1 - A
1250 113.5 95.8 1 - A
126.2 114.3 96.5 1 - A
123.5 112.2 94.7 1 - A
NOTES- TESTS PERFORMED PER ASTM D2922.96 & ASTM D3017.96 'COMMENTS: 1, FILL MATEf tIAL A. TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIEEgg SH WN" Lbs, per cubic foot 2. BACKFILL 8, PERCENT COMPACTION DOES NOT COMPLY
WATER CONT NT: percent of 0 Weight, 3. BASE COURSE WITH SPECIFICATIONS
PERCENT COMPACTION: Base6 on rriaxlmum dry 4. SUBBASE C. RETEST OF PREVIOUS TEST /�
eansCln mbe�r. on, sample lntliCatatl by 6, SOl ECR E. MOISTURE BELOW SPECIFSCATIIONIC: TIONS
*� (1) ASTM D1557-00 METHOD A 0
TEST INSTRUMENT; STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement- ADJUSTMENT -DATA M: D:
TECHNICIAN: Juan Nunez
Respectfully submitted,
Professional Service Industries, Inc.
TUU9 TEST RESULTS APPLY ONLY TO THE SPECIFIC LOCATIONS NOTED ANO MAY NOT REPREoCNY ANY OTHeR LOCATIONS OR ELEVATION::.
REPORTS µAY HOT 0E REPRWUCEP, EXCEPT IN FULL, WTHOUT WRITTEN PERMISSION OY PROPESSICNAL SERVICE INDUSTRIES, INC,
Professional SO(VICe Industries, Inc- • 42-240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 760/341-5790 - Fax 760/341-5794
PS11.100.2 CQF '