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0006-128 (SFD)`LICENSED CONTRACTOR DECLARATION I hereby ai,, rm 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. L'eense # Lic. Class Exp. Date 73Fi920 �3 �'�� Cirsl30/2( �.,.� 0 Date '' 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 EXEMPT Policy No (This section need not be completed if the permit valuation is for $100.00 or less). () 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any miner so as to become subject to the workers' compensation laws of Califor,5ia, and agree that if I should become sdbject to the workers' compensation�pro +isions of Section 3700 of the Labor `Dode, 1 hall forthwith comply with tho$�1 visions. ate: � � 1' � Applicant 11V - 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 ajl City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the%above-mentioned property fotr i 'section purposes. � �n� 1; ,V Signature (Owner/Agent) i Date w PERMIT#BUILDING PERMIT 0"-128 DATE VVALUATION LOT TRACT S92,987-407 BL1iC253 vxa JOB SITE APN ADDRESS 54-1.25 AVEMA 0)-RPX- GOI1 774-•240-021 OWNER CONTRACTOR / DESIGNER / EN (NEER LA QLUTA PARTNM COxdT1..B PORARY HOIvSiE;tS PCS BOX 450 51370 AMNDA,BERiF/1CUDAS LA. tQUINTA. CA 92253 LA QUWrA CA 92253 (760)5CA-1962 CM# 6255 USE OF PERMIT 1GLE FAMILY DW ING 9PD-PERM17 DOES NOT IWC I UDE ffLOCKWAI, LS OR.. P00t, TRACT CUNSTRUCTIO2J 1,492,00 nP POkCN/PA..tIO 40.00 SP OA17AGEICAIi1' ORT (Sf) 9,074,80 5 FT. YO0D FEN C9 200.00 LF ` 19AiDA.wrED C®5T OF Ct9Ngmuc1'yo 92,95`�.+BU PE'RMU lk°bX SU, 06ARY C0NSY'RUCx1014 F-, 101.000-438.000 $698.90 + PI.M4 CHECK PER $505.53 MFWH9N1CALIEE 101000.421-000 $53.50 ELYX,TRIC!'.L FEE 101-000-420-000 $I30.98 PLUM131AI0 FIR 101.006.419-000 STR,ONO MOTION FEE • R.ESID 101-000-241-000 $4.30 ORAL YNO FEF 101-000.423.000 $20.00 DEVELOPERIMPACT FEE $1,901.00 PRECISE,PLAN 101-000.441-345 5109.00 ~:'? f?',P4 DEPOSIT 101-400-439-318 • a a.o(I " •sf't SM -TOTAL CONS"l RRUC ION AND PLAN tr'EE01C $3,449.06 LM PRE -PAID M. M 4250,00 TOTAL F-wamin,nxs DUB; NOW RECEIPT DATE BY /�� DATE FINALED INSPECTOR JA INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings . Ducts Slab Grade Return Air Steel Roof Deck .—O Combustion Air Exhaust Fans O.K. to Wrap — �1 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 Z b 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 O Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection p �7 Encapsulation Gas Piping Gas Test l Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 7 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) _ . p COMMENTS: Building 154 Address J `�' to C P O BOX 1504 �n 78-495 CALLE TAMPICO AF 12 �I ,� ��' i C-� A°QU/INTA, CALIFORNIA 92253 OOow _ / C:7 -_b u+0 -f4 nl.2Te)c-:;-, C. BUILDING: TYPE'CONST. OCC. GRP. A.P. Number_ -7�7 4-, � I J, ( Legal Description `,- / -7 ��'-' L a Project Description 55 � t. ,C F; T -A w , L. -P 'PiSl1 � Mailing �,{'- Address T), o -.)K 4-0City Zip 111 �� Tel. ( UI.Tg_ I If? -Z; 3 1 JL4- (EYD4V Address (-)•� CA State Lic. �� City 8� Classif. �j`(f � Lic. Arch., Engr., Designer r_>n� /!�/o P' AddressTel. .Wu, x,x 4-<-() c 6 4 / City Zip State c, ( 2z C" 3 Lic. a 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 Contractors 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 for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty or not more than five hundred dollars ($500). [] 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.) 1 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 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 ] 1 am exempt under Sec. B. & P.C. for this reason _ Dale 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 r7 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 ($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 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 applicant Date Mailing Address City, State, Zip Sq. Ft. 1" 2 No. Size , 1 Stories New Woo' Add ❑ Alter ❑ A,,-,-rrJe_ !U, -=— Estimated Valuation No. Dw. Units Repair ❑ Demolition ❑ PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure r TOTAL U A (J REMARKS j 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 PermiyJitF1. Validated by: '•r �. Validation: J/ 4_9111 QUO Mai WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION f' mesert aanus unineu acnoot Ltstrict ! 47-950 Dune Palms Road Notice: La Quinta; CA 92253 r :w Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 7/12/00 APN # 774-241-021 No. .20695 Jurisdiction ' La Quinta Owner NameLa Quinta Partners Permit # No. 54-125 Street Avenida obregon Log # City La Quinta Zip 92253 Study Area 'Tract # Lot # Square Footage 2993 Type of Development Single Family Residence No. of Units 2 Comments Two CC checks for the total amount of 5776.49 and the difference of $359.16 paid in cash. Cash received from Mr. Robert Kellogg CC# 7019275 for $2,890.93 CC# 7019276 for 2879.56 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 mob ilehomes. 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 2,993 or $ 6,135.65 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 �: ; �;.•ndZi� !' Fees Paid B cc Union Bank / Robert Kellogg By gg Telephone 564-18.�6_e, Name on the check ;V I 4,`» •r'.. �. 1 By Dr. Doris Wilson •' -'n. Superintendent Fee collected /exempted by Sheryl Simmons Payment Received $6,135.65 Check No: see above - Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 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 JUN.12.2000 2:23PM COMMONWEALTH 77-/7/-% >0YXac: 21 AecordinQQ AeQQuoered By CHICAGO TI1'I.E COMPANY cimejwomemm =mono ave ORC TR compmv CON►ANY 97066egf mfr oaebiaa� n ate BM r!D, .11111ma wr°�f �oaaa, ROBWT a. ua`uca ine�vi� Dusan►. CA 9aa53 NO. 067 P.2/2 a►rOzo o� s . G'RANT DMw . ; ^ 0 nd me. roloned �rentorleJ declpzq(e)� �!�ACCoss33�� trgnoler tax !o ► PC.I0 • n�►leod on �li value o ( l noCc * oA luii ' W 1ua le oro? na o d ve d or eporatad area, ( city os raneaa rerllpi�ting at time,o��®le, e• I" A ggi,(yyt�,A CON�i09RATxCt4, ='BCeipt ax Mhdch Is harevy aoknorle"L-d, TRUME op "to !lathes SMVDCMU TaWT MTap APA�f, as. idea and JM� �oalaR • . � aer.ey veAl�r cap tp max, R08e(iT 8. t kU"G and anVIA K I HO11BS B1+LtI00. husband and Mira ae joint tenants UAA Cc!<�OttBA R'1'81N Y she,real prOPOrt;y in the city of a dovcribed an,--- � 'A� County of RIV41re3da, state og cq�igornie, u3te 6 7 in 81ock 163 ,end LO i Unit Igo, R6► nra Cary A to at o9 0 lhtrOugh Si, rin�lti0l�►a l� Block 065 0� fit: 19( wee 16 Bad 13 a6' Va3e lw Guinea,'ae otmwo by Map an file in Book Rated August Is, ,�f9! �e� saoordo °� h vawAd4 Oava litorui4 Rate of CA Bern CaYnty or e � Aetore, )me S•D, USTR8 Lyn41U*OBItl9aw1111Y aQPec�rAd a �heaeao4a aIgnoWn t aeeo(or proved to me . the pIereonIA whose naps orridancap to Im Co the w rhln inAerurtMht ;a " oubaersbed nP has oho/they exem4ed tee name 4nd to _ ��++ Her r auth9rized 4404eitYI and C0►n^, t h!I /her/Che lac etgngt,�q (d1 on the U* -.-C 0kvdo , inot;zvBw it' the person (e) , or the egClty upon �� ++!� 4whelf or rhieh the poreon n'' �"*0� "' �•�vi {�! ace�4d 9 ro i ,0 oho instrument. I executed a Ni'S11868 ey hand d otelai 1 e Signature VAIre nx 1$ vial IThia area for all jejal naCerial aaall. I 3D Tl163S' �QW0.1Sn:) wu ;0T 00 060 Nflrf t 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, in order to determine the applicability of compatibility issues or need to require the filing of Master Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as'necessary. APPLICANT LENDEL VENTURES SITE ADDRESS 54-125 Avenida Obregon APN 774 _ 203 ,_ 019 - BINNO.: �`� CASENO.: 2000-236 LEGAL: LOT 7 BLOCK, 253 UNIT S.C.@V.L.Q. r - CHECKED BY: Greg Trousdell DATE: Inform the assigned Building plan checker .upon your assignment to. this case. The CDD Executive Sgcretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review Case logged and number assigned. Verify legal and APN information Consistent with MDG on file (as -applicable MDG filing required (5 filings since 9/3/98) Consistency with street/surrounding area: 7!(�, Colors pA Materials Architecture C LRequirements: Gj i La Quints Partners Post Office Box 134 La Quinta; CA 92253 July 11, 2000 City of La Quinta Building and Safety Dept. Post Office Box 1504 La Quinta, CA 92253 RE: Plan Check for 54-125 Avenida Obregon To Whom It May Concern: Please be advised that as owner of the above property, I have hired Robert Kellogg to build the project under his General Contractors License number 736920. Accordingly, please remove Lendel Ventures from the Permit Application. Thank you for your attention. Sincerely, La Quinta Partners Certificate of Occupancy City of La Quinta .. Building.and Safety Department c�tiw- 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 Cityregulating building construction or use. For the following: BUILDING. ADDRESS: 54-125 AVENIDA OBREGON -Use Classification: ' :SFD Bldg, Permit No.: 0006-1.28. Occupancy Group: R 3 . Type of-Constr.uction:. VA Land Use Zone: RC .Owner of Building: LA QUINTA PARTNERS Address: P.O. BOX 450 City: LA QUINTA, . 'CA 92253 By: STEVE TRAXEL Date: 03-02-01' Building Official l POST IN A CONSPICUOUS PLACE