9911-216 (BLCK)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
04611201
uat 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.-.-
(
eclarations:( ) 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 GOLI.),C E: S. Policy No.
N%VC 0u 042
(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' compensart—icon provissions•of Sectiof"i 3700 of the Labor
Cod 1 sh I1,forth Ith comply with those provision
yD`atg/� ,jr Applicant's , ' , .4 �'(.✓d`" Y� -
t �.
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.
BUILDING PERMIT PERMIT 119911 -
DATE VALUATION SZ -500.40 LOT (2 TRACT MA264 U
JOB
ADDRESS _4—M54�75A�'�?;,I�IIV't�.Ok�.�X���L,,.ONK APN 774.241-02.1
OWNER . CONTRACTOR / DESIGNER /ENGINEER
T;�uh NiUTS, .L'.IA KL r.•t0G COYONR.t1 v f�
PO 60N.339 51-54'G MSt`sNrriOAir R DR_
CA 02753 LA. QXR1'aUA CA 922;;2k
USE OF PERMIT
GENERAL BUIXANO
6, ' '•
ALT..
X0.00 IS
T.'E.I. T F EC SdiM.hii'AR'&`.
C'OMfIUt3 711(?N:!•'93 WI -W)419 -ow
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 ve mentioned property for inspectioJJn pur oses.
q' ) / RECEIPT
,Signature (Ownery/Agent�- �-- -� t4 Date � � � J!
SU B-10fAl. C'(��,'K 1'l{t,fc'Z E''(ON ANP PLAN (' -WCK.
LESS 1-I&i -T'AM FEES
'R)'6'Ai..!''E#dMf.TFUF:.' Dt)F NOW
2 QTY .09
DATE I BY I DATE FINALED I 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 -
BLOCKWALL APPROVALS
_ POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
�Z, (, - QQ S%
Main Drain
Bond Beam
lZ=lam _ Q f :57
Approval to Cover
fool as
4- 17 - 00 TV-
Equipment Location
B
Y -1 9 - co <4K_
Underground Electric
B3
Y- 24 - Ov
Underground Plbg. Test
Final
z _ —6z_J
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
I 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
Underground Conduit
Rough Wiring
Low Voltage Wiring ,
Fixtures
Main Service
Sub Panels
Exterior Receptacles r
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
AUG.25.1399 2;01PM 6,*hbNWEPLT1A ° NO. 840 P.V
RECORDZUG REQUESTED SYi
CHICAGO TITLE COMPANY COMPANY
99.9036KC 97065898 J
MEN RECORDED XAXI, THIS DEED .AND,
MIXtESS OTHERWISE SHOWN 2ZLOKt
Kh1L TAR STATEMBNTS TO s -
R08ERT R. KELLOGG
and SYLVIA KELLOGG
41785 VIA TRIESTc
LA QUINTA, CA 92253
SPACE ABOVE THZS LINE FOR RECOF.DEAIS USE
APXT 774.241-023
GRANT'DEED
The undersigned grantors) declare(s):
Documentary transfer tax is $,00
(XXX) Computed on full value of property conveyed, or
{ ) Computed on full value less liens and encumbrances remaining at time of sale,
( } Unincorporated area: ( ) Ci--y of ar.d
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JUDD MARMOR, TRUSTEE OF THE MARMOR REVOCABLE TR•CST DATED APRIL 25, 1986 and 3tDD MARMOR,
A WIDOWER
hereby GRANT(S) to
ROBERT B. KELLOGG and SYLVIA KELLOGG, husband and wife as joint tenants DBP. CCNTEMPCRARY.
HOMES
the real property in the City of LP. QUINTA, County of Riverside, State of California,
described as:
Lot 12, Block 265, Unit No. 24, Tract Santa Carmelita at Vale La Quinta, as per-map
recorded in Book 19, Page(s) 44-45 inclusive of maps, in the office of the County
,Reco:rder, of said County.
Dated August 1, 1996
State of California
County of } S'S. JUDD MARVOR, TRUSTEE
On
before me,
personally appeared JUDD MARMOR
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(s) whose name(q) is/are s,.:bscribed
to.the within instrument and acknowledged to
me that he/she/they executed the name zr.
his/her/their authorized capacity(ies), and
that by his/her/their signature(s) on the
irwtXUment the person(s), or the entity upon
behalf of which the person(s) abCed, executed
the instrument.
. g
WITNESS my hand and official seal,
Signature (This area for official notarial seal)
MAIL TAX STATEMENTS TO:
RC District - Planr►ina► 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: CORONEL CONSTRUCTION
PROJECT
ADDRESS: 54-475 Avenida Obregon
APN:. 77472.41-023
LEGAL: LOT 12 , BLOCK 265 , UNIT 24. S.C. @ V.L.Q.
CVD BY: Greg Trousdell
BIN NO:
�C- CASE NO. 99-116 CHECK -DATE: T
Inform the assigned -Building •plan-checker-.upon:youur_assignment to this case. The CDD
Executive Secretary maintains a -logbook -to -track -applications and assign case numbers.
. :77:. REQUIRED ITEM �.
Y N I COMMENT/CORRECTION
.; . . �; y,x;:..:: t4., ., �� • �v� • vvn \ "•.:.
U
�4t:: ••\t� l.}�.(4\+fC\C{�'C`••£h'ii>;. \ �a`�h. S\.}'•b i. 2•
�C�3..1.I�Fp3..?►13)�f3�T:��l�?h . a.�c^.��`
Case logged and number assigned
.vim\n}ti v vyv,�:Q}'Q::}i'•:: a:4:$i }Y:>f'i�`tW.
(. pp .�.'.}i 4 a`;C✓.S1�ti \4
Verify legal and APN information
Consistent with MDG on file las applicable)
MDG filing required (5+ filings since 9/3/98)
Consistency-with-street/surrounding area
Colors
Materials
Architecture
sk
�6
OTHER REQUIREMENTS:
The zoning code, architectural and landscaping manuals, .and/or. assigned inspector should
be consulted where 'uncertainties arise. The c pleted checklist shall be maintained in the
Building .& Safety address file.
l�