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9910-173 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (comrnencing with Section 7000) of Division '3 of the, Business -and - Professionals Code, and rry License is in full force and effect. License # Lic. Class Exp. Date 634981 r Date `''� '� Signature -of ContractorOWNER-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). ( ) 1, as owner• of the property, am exclusively contracting with licensed, contractors to construct the project (Sec. '7044, Business & Professionals Code). O `Ikam 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: �(*)< 1"have and will maintain workers' compensation insurance; as -required by �Qiio' n -3700 of the Labor Code, for the $erformance of the work for which this permit is,issued.,My workers' compensation insurance carrier & polic. 11y no. a1.re; Carrier 7. , ,_f' ! PolicyNo. Ct 11) TON LiP�C31LE. flv', (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'. compensationlaws of California, and agree that if I shoulftecome subject'to the Workers' ,cori pensation provision sof-Secti n 3700 of the Labor ' h�od ; I sh I orthwith complyr witRthose•provisions-7-,/� t A • "','/Applicant Warning:. Failure to secureWorkers' Compensation coverage'i 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 Applicatiori.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 thebuil:ding construction, and hereby authorize representativesf this City to enter upon the above-mentioned property for inspection purpo es. 4o Signature (Owner/Agn 3Z'� Dat r Jam,,., z i •• ' � ag. .. BUILDING PERMIT PERMITu#y pe DATE (� j VALUATION $104,734.60 LOT' I I TRACT RLK.21 -5 U2 4 Ily JOB SITE u� �1.r�ii.�iI� ADDRESS TPN,Ylr-��1�-�w�� 1 OWNER' CONTRACTOR/ DESIGNER/ ENGINEER ' Drtov,p7' c4 a'v s vvA Kr I Iy flu -r., kJ1301A.♦ C.4, +.17.4 r<.%t•�.ue i. sti.Ivwit,n •) j'�dy^�qo7l�iena§ �!-'1.'+8'rytYUi.477-78.5 E VFA'I'�. ESl l' 51.540 It'I EU -HOW & DR, i;AWIN7A 9Ti +3 tdkQ11`t.NTA. ' CA 92253 _CA _ QM). 4-+ 604 ` {':LILP 2761 •• .• USE OF PERMIT �i..�4Cal.+.I.h-li.lV3.j<3..�° i:�1►N�).,d 11'•[4.1 - -. - _ , '�{' .9kiA"4.,. �NxY A,9 k�c t�.Y�'C.,s SSV.�.'lrM1�o�...'F...m.A�i.'4.�11/Y,a 4. �1Y�'4 .' �¢f•`W�:.4 �J.7'.�1� Cf,�'iv;Riiiritw.'.wts t�31.-CIS+© 4141IJ(i s++g7.ix3 PILLN 0'te(.1_K Mr. 1 - ib:11XI IAMCAL.1�: 2 ;0J. Qt OM1 QJJ V1'3,tto .� U —0-MCAL i f ER. S139.52 PU.i>r'➢H1WJ FEE., 1 1 4)(Jt)-X1:1 -tif #(j t a. 2.2,75 iZVl"O 101-000=2. i (JJ Ilk 44 . . rri;•e�_°z�ra f�� .. � c8:@warty)-aw� ��3iE � f3.11n . ''�a�1.'I..(���r�l� >7�!i12Ni..'�21:•'�4�Y 3"'+�.211I�%.4itj • 101-000-441 -345. FLIIR'i V4Pli)fi[,%r t�f A,<.t+. i-RR,3t4;, go t}iiQ1,?S`�%ifjdl �pt?,�itt i"is"i t 01-CJt1-4a� ;Si .i"'i�C�:;i SIV -9-1,110 TAL COl WURU011ON "A1' D PLAN t^H1 CK IZ;359i 86 1 . LESS V:EE:k;•11MO E'RES- 4250.00 • T01WUPEL\I7U7;'. EES RUE.I iIA it ti 1 RECEIPT DATE jA / f BY I j• DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings a � Q C S!� Underground Ducts Ducts Slab Grade I'y Return Air Steel Combustion Air Roof Deck�r�� / Exhaust Fans O.K. to Wrap F.A.U. Framing _ a�ag_ tX> r Compressor Insulation - G 60 57- Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 3_ ry.00 $T Final Final g � GRA S— POOLS - SPAS BLOCKWALL PPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping Y PLUMBING APPROVALS EasTeslectric Final - Waste Lines Water Piping Qg Sr Heater Final ��/� 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 COMMENTS: Final �j/:� � � s 7 - Utility Notice (Gas) (9 a ELECTRICAL 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) Pe -7 �q�a X93 • (3&el,�� 15 -LI 4 4 /d , , P.O. BOX 1504 APPLIC ON ONLY Building Lr . 45 �%%�,, `, 78-495 CALLE TAMPICO Address S� L hJI' 1� LA UINTA, CALIFORNIA 92253 Mailing (, &L��' City .1 � Zip ITel. Contractor i Cl. j/ zv w r I Addr s �• J' �� tv�� > t3 `J Y,4 6)tAt ! 44 1 Zip 71%> Tel. ;&/_ State Lic.% / / City & Classif. ! C'' �L` C Lic. # -24? (� Arch., Engr., Designer Address I Tel. City IZip I State # LICENSED CONTRACTOR'S DECLARATION I, herebt,affirm that I am licensed u der rovisions of Chapire-M( ommencing with Section 77000)eVec; } D)vision 3 of he Bus'ness a P ofessions Code, and my cense is i fJll rce a GNATice. DATE OWNER -BUILDER DECLARATION I hereby alirm'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) 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). I] I, as owner of the property, or my employees with wages as their sole compensation, will d0 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. It, 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 II' 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 7 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 F7 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 thg 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: It, after making this Certificate of Exemption you should become subject fo 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 r� tt BUILDING: TYPE CONST. OCC. GRP. A.P. Number I�) LI -- - X11 0 ' / Legal Description t `'A 17.1 f� IV-' -2 4-5 y�' I � 2-11 Project Description 64—�>- Sq. Ft. ' , No. J No. Dw. Size % Stories -•w^" Units New boio"_ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. C� 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 Side, Setback from Property Line FINAL DATE P.rr - - i INSPECTOR_ Issued by:- ' • 1r0' Date Permit Validated by: Validatiorx- r- �r � y WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 11/19/99 APN # 774-241-022 No. 19635 Jurisdiction La Quinta Owner NameRobert & Sylvia Kellogg Permit # 9910-173 No. 54-455 Street Avenida Obregon City La Quinta zip 92253 Log # Study Area Tract # BLK265U24 Lot # 11 Square Footage 1696 Type of Development Single Family Residence . No. of Units' 1 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 or replacement mobilehomes. 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 1.93 X 1,696 or $ 3,273.28 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/Union Bank of CA - Mr.,,Kellogg Telephone 564-196_2 1. W Name on the check k By Dr. Doris Wilson..`_ . Superintendent Fee collected /exempted by Juanita Green Payment Received $3,273.28 O Check No. 6528673 Signature NOTICE: Pursuant of sembly Bill 3081 (CHAP 549, STATS. 1998) 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 rurVrom 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 Distdct('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 Certificate of Occupancy City of La- Quinta Building and Safety Department :F :F 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: 54-455 AVENIDA OBREGON Use Classification: SFD Bldg. Permit No.: 9910-173 Occupancy Group: ' R 3 Type of Construction: VN • _ Land UseZone: RC • T Owner of Building: ROBERT & SYLVIA KELLOGG /"7Building Official Address: 47-785 VIA TRIESTE . City: LA QUINTA, CA 92253 By: STEVE TRAXEL Date: 08-18-00 POST IN A CONSPICUOUS PLACE r PLAN TAOS ELECTRICAL'LOAD CALCS uVM I �CKT DESCRIIION " . 1/OLTS CECT N® `®F V®TSAIVIPS TO'AL AMPS r USN_jTS 120 V. MULT•' OUTLET CKTS '- GEN,LTG @ 3 W PSF• 1.20 15:. ' .1,696: 3 5;088 SM APPLIANCE CKTS 120 20 _2 1,,500 3,000 GRI CKTS. 120 11500 15.00' SUBTOTAL 9;588 '120V SGL OUTLET CKTS DISPOSAL 120 202,400. :: 2;400: DISHWASHER 120 20 1 2;400 :2;400 LAUNDRY : 120 20 1 2;400 •:.2;400 HOOD 120 3 1 —360' - 360. SUBTOTAL 7,560 FIRST 10,000 V-A ,@ 100% + . 10;000". BAL V-A @ 40%. = : :2i859 -SUBTOTAL 12'859': RANGE 230 9;200 .9,200. A/C (LARGEST FAU OR A/C) 230 30 61900 '61900 TOTAL V-A a . 28,959•. S'ELECI" SER�UICE SIZEI �` TOT�AL�V��A�'. �X289°5,9� ��; * <25,��9�i�NIPS - Y. PLAN: TAOS ATTIC VENTILATION ATTIC AREA: 1,696 SQ FT 533 SQ FT TOTAL 2,229 SQ FT 2,229 SQ FT / 300 = 7.43 SQ FT REQUIRED 9 VENTS / 14" X 18'.' VENTS (1.17 SQ FTX 1.5 SQ FT) LENDEL: EXCEMY DOMCALMATTIC TAOS 10/29/99 P,IANSHOWS'9,.zVENTS 6 LENDEL: EXCEMY DOMCALMATTIC TAOS 10/29/99 -- �NOV.03 199 10!0SAM CUSTgPP SERVICE Roo 40 A•quested 6 tvMtCAaO TITLE COMPANY tifomwe Wmsevi us CKCAW Tr1w awry Y cwpM r 99.9076CC 9705699a nu om am. ter own YiL !A; To. RaeaaT a • a�'nsa vr�i►� :� Qr1tlriA, ch Blasi c "c so IL0961—:880678 NSM/ NI1M1 a.N eaN t�l Oat T IMql/ M ie atliell(qw7 L. ear. �M�tr K Iltwniet Mora w, "Aly Cava 4 satardtt h rM 0 P. 1/1 GRANrDEW AMI "gill iffil fie wi0erot; ad us doelare ols oeewaWWA 7► trenus a fa $199.90 )oar3 N, oo ;Er."u.1" of alr�aQmr.�d, os ( 1 dvileprpentsd an&A cieyy of a Oet�branar rwte�ttq �t etre of lo. 6 ON A VAZWJUCOM U M4'iOM, rectipt Oi which is hacaby aoknev saved. MD k;11 o, 7 UMA OP W HAD= M1VVAU8 2198T nWM AyuL 31, loss and I M9 lOwo", A MLOOMih heraby WAM(d) to RCUM s. K=10M and tlnV" MUAOW- husband and Oft 40 Joint' tenants ORA CarMp ny UMB the real property 1n the city a QMWA. Oouaty (LLwOroide, state of Nifforalo. described 401 &ate sine 7 in Mock 263 Lots a through ia, iro ve in ideals ad$ o! Halt Mo. 34. •urtb Caneelita at vale L 94inta, e9 a by Map on filo in Peek %a, lapse 46 er4,41 of Maps, eater of s"/esretde Atoms" Dated AM/set iso loft j Stats of Cala ornis II ` county of O � e f as. on Delors me. - JIMMY WWW_ personally known to M (or pm ad to go on the boats of natirfactoty evidence) to be the parean{d whose naMaj/).lelan! subscribed to the within lnetn+msat and 40M MLedged to !a that she/they executed tho uM ie r ti /Aar r autborlsed cap4olty/1MM. end o►�_C b,& t r/thele ai2n4taretA on the�� ta9trvnant the pereon(4 . or the entity upon 1%2= behalf of which the permVI aeted, to Mtod the Instriment. "llusse W40 hand oinel 1 t S3gn4ture4o(Me arse far official notarial 10431 ti1116 sAi 0 soy I A ' OCC ON SM089 83MOd RC District - Plan 'n 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 Building & Safety as your correction list. Please attach additional explanations as necessary. APPLICANT: PROJECT .��{� `i�� �T�e f�� Y•� ® - ADDRESS: APN:. LEGAL: LOT _, BLOCK. UNIT �`i" , S.C. @ V.L.Q. CK'D BIN NO:. CASE NO. `7 CHECK 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 ................: w:::: •:::::.; .. ., .,:: .::4..; . .`�.�`: i`Y:4:4••":,: •: •?: n•::: U:.v::•^ •: nw: n, v.:: „• •.,.:::: • •:���:2\,:::. .:. : ,....:viii :$•ii��:��'4; <:: p.":..�:... n :v;\ Z n .,� ;•: �;.;i`::;•`;i::;•. .\:..:��, •: �, .\i:i: i::;;:;••C::�::'..�;?::: �:J:i.�:••:\`fit. � Case logged and number assigned Verify legal and APN information Consistent with MDG on file las applicable) J MDG filing required (5+ filings since 9/3/98) Consistericy -with-street/surrounding area:- Colors Materials "Architecture . / c 0 - OTHER REOOIREMENTS: The zoning code, architectural and landscaping manuals, and/or assigned inspector should be consulted where uncertainties arise. The completed checklist shall be maintained in the Building & Safety address *file.'