0309-018 (SFD)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
c,,S?
.'g01 13 (' Is �i7l;112C
Date 3. f,� G a 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.
( ). 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 STATE. FUND Policy No. 2".1 001 M-4003
(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: _.f I Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date;
BUILDING PERMIT PERMITN
(o �$
DATE VALUATION LOT TRACT
09KWOC $113M.7.017 14
Job SITE
ADDRESS W-720 K=NH0 D17.
APN
774-13.1-011
OWNER
CONTRACTOR / DESIGNER / EN (NEER
THOMM RUIMN
DAVM 7.. A7SDTN&IXON ,
FSU, BOX 134
41.780IiF.1t11I1T1 `ACrE 17R
LA QUAdTA CA 92233
SERMUl3A.DLIAS CA 922011
V60>408-7528 C B1d1 3724
USE OF PERMIT
SI NGIZ F)gvW_Y DWELLING
1914 SY. SFD PERMIT D09,;,N07 INCLUDE $LOCICWALL, P001.JSSPA
OR DRIVEWAY APPROACH, 7SV6 REDUCED PLAN CHECK FEE FOR
MU'LTIPL'E PL"S OF SAME TYPE
T;kArT CONSTRUCTION 1,914,00 8F+
PORCHWATI.O 36.00 SP
GARAOFJCARPORT 480:00 8Ii
X-FITMA'M COVT OF CONSMT1TC" 1'.1ON
1113.8170)
i'ERAtYT' FIM :iUM114RY
CONSTRUCTION FEE 101-NO.418.000 v6sst54
PLAN CHECK FEE 101-000-439-318 $143.96
FEE DEPOSIT 101.000.139.318 4250.00
MECHANICAL FEE `101-000-421-000 $65.50
ELECTRICAL FEE 101-000.420-000 $115.09
PL UMi RiG FEF 101-000-41.9-000 $14VIM
5TRONO MOTKNJ FEE . RP;,4ID 101.000.241.000 $11,38
(3RADYNO FEE 101 -000.42;3 -WO $13.00
DEVELOPII;R. IMPACT YEE 52,405,00
PRECISE PLAN 101-000-441-345 11100.00
UkI-Tl C0knRUC-17014 AND PLAN CMG1K
$3,696.33
pL - 9 PRB,-PAID FEES
-$250,00
161003 w -m. P x:m-Es Dm NOW
VA4&33
P
SE
�ptA
DEPT
Cl � NpNCE
o�
RECEIPT
DATE
BY'
DTE 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
Exhaust Fans
O.K 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 I Iry Im
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Ptbg. 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
7 Q
Encapsulation
Gas Piping
Gas Test
c0
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 9/16/03
No. 24973
Owner Thomas Buffin
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
4�S�Ft�scyo
.� cS�t1T1FU�/J,•, o
Q BERMUDA DUNES h
C/) RANCHO MIRAGE d
INDIAN WELLS
�.� PALM DESERT ,y
LAQUINTA
4INDIO `^
O Yl
774-131-011
Address
P.O. Box 134
Jurisdiction La Quinta
City
La Quinta Zip 92253
Permit # 0309-018
Tract #
Study Area
Type
Single Family Residence
No. of Units 1
Lot # No. Street S.F.
Lot # No. Street S.F.
Unit 1 14
53720 Eisenhower Dr 1914
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 1,914 S.F. or $4,095.96 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 CCNIB-David Addington Check No. 287438
Name on the check Telephone
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Yolanda Garcia
Signature
Funding Residential
Payment Recd
$4,095.96 Over/Under
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
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 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.
c
APPLICANT: t -o ►i
.SITE ADDRESS: 53 —1-10 " &6ev.. u W �-
APN '7'7 --)-31 CASE NO.. 68
LEGAL: LOT I�- _ BLOCK UNIT.
CHECK AND APPROVED BY:
S.C.@V.L.Q.
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
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:
Architectural design features
G�t`1
A W
okt 'Dept..''
O
el
EXh�
Q
Cond�it0ll
Other Requirements:
RC
Al
IE
cE
UN -15-2004 06:37 AM ,
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING
P. 01
'64-
CF -4R
Plan Number
HERS Rater Telephone Sample Group Number
A--- G/-7/10 4
King Signature D to Sample House Number
Firm: HERS Provider:
Street Address: - 2 z, -'o via uG� /Y. Clty/State/Zlp: C. ��a 42 't �f l�y,O
Copies to: Builder, HERS Provider
HjRS RATER C 1ANCE STATEMENT
.The house was: IV Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing dlagnostlo testing and field verification, I certify that the houses Identified on this form
comply with the diagnostic tested compliance requirements as checked on this form. ,
�1 Distribution system is fully ducted (i.e., does not use building cavities as plenums or platform returns in Ileu
�f 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 B% 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) _ , L7 /o
Check Box for Pass or Fall (Pass -6% or less) ❑
ass Fall
THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent
2fYes ❑ No Thermostatic Expansion Valve (or,Commission approved
equivalent) Is Installed and Access is provided for inspection
Yes is a pass
CI MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. O 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. 0 Yes O 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 =
Yes for both 1 and 2 is a Pass
T "�
Pass Fail
110h
❑ O
Pass Fail
Certificate of Occupancy
T40f oF4aukrw
Building & 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: 53-720 EISENHOWER DR.
Use classification: SPD Building Permit No.: 0309-018
Occupancy Group: R3 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: STEVE TRAXEL
Date: 6-16-2004
Building Official
POST IN A CONSPICUOUS PLACE