08-0170 (POOL)54450 Avenida Alvarado
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78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
]LENSED 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.
Lic. Class Exp.,Date
634981 B f 01131/2(
Date Signature of Contractor 4.
License #
• (
OWNER -BUILDER DECLARATION
1 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 134293740
No. 134x937 -dig
(This section need not be completed if the permit valuation is for $100.00 or less).
.y ( ) 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 ithose provisions.
Date: Applicant ~
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. •
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and'State laws relating to the building
construction, and hereby' authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)' Date
BUILDING PERMIT PERMIT#
DATE f'' , , VALUATION LOT Cis -170 TRACT
/1 ! lam.! ` iii
JOB SIT
APN
ADDRESS
54-450 AVE IDA ALVAR DO
-, -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
BOB R ELLOC3
CORONE L. CONSTRUCTION
47.785 VI3.RIESTE
51-540 E1 ] 4}?O1 r.17R
Lt QUINTA CA 92253
LA QtJINTA CA '92253
(760)564-4604 C 3LU 2261
USE OF PERMIT
POOL ANDJORA
POOL ONLY.ALARM5/B.AJtRIERS SHALL 8E IN PLACE AT PRY,' PIASTER
INSPECTION, POOL EQUI.PMEWr F.NCL01IUR! IS NOT INCLUDED .tH THIS
PERMIT
POOL .AND/OR vPA 8 ODD.OP L4
ESTIMATED Con OF CONSTRUCTION
€3$)00.00
PERMIT FEE SUMMARY
PLAN CHECK FEE 101.000439-318 $64.35
CONSTRUCTION FEE 101-090-418-000 $90.40
MECHANICAL FEE -- POOL 101.000.421.000 $24.94
ELECTRICAL FEE — POOL 101-000-420-000 $45.00
PL'UMF:e1N0 FEE -• POOL 101.000.419.000 527.00
i
Towel., CONSTRUCTION AND PLAN (`.LTC .
$259.31
0 9 2®Q LESS PRE -PAID IEE
0.00
PUG \INC .
1... Q e..)'I'A>a PPR:M_:fl FEES D NOW
t.
a. r111aiEii
-*
X59.35
IE
RECEIPT
DATE
BY
DATE 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 1
Roof Deck
Exhaust Fans I
O.K. to Wrap
F.A.U.
Framing
Compressor 1
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls i
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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
COMMENTS:
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)
Notice:
Document Cannot Be Duplicated
Date 1/13/00
No. 19903
Desert Sands Unified School District
47-950 Dune Palms Road
LaQuinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameRobert & Sylvia Kellog
IIIIIIIIIIIIIIIIIIIIIIIII 79
APN # 774-241-010
Jurisdiction La Quinta
No. 54-450
City La Quinta
Tract #
Street Avenida Alvarado
Lot #
Permit #
Log #
Zip 92253 Study Area
Type of Development Single Family Residence
Comments
Square Footage 1696
No. of Units 1
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 California/Robert Kellog
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patin
-----/Q-(1641C—
Signature
V;(4i
Telephone ; 760=564-4604
Payment Received $3,273.28
Check No. 6528948
•
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
Recording Requested By
.
CHICAGO TITLE COMPAN
RECORDING REQUESTED BX:
CHICAGO T::.TLE COMPANY COMPANY
99.9C36KC 97056898
WHEN RECO:LDED MAIL THIS DEED AND,
UNLESS 1)THERWXSB SHOWN BELOW,
MAIL. TAX STATEMENTS TO:
ROBERT B. KELLOGG
and SYLVIA KELLOGG
47785 VIA TRIESTE •
LA QL'INTA, CA 92253
,170A.,640-4.0)S—
MA undersigned grantoris; declare(s):
Documentary transfer tax is $19(.90
(XXX) Computed on full value of property conveyed, ox
( ) Computed on full value less liens and encumbrances remaining•at time of sale.
( ) Unincorporated area: ( ) City of
IIIIII I I III IIIII III 80
IE
DOC Iii 1999•--.38se7at
08/•" '199S 68:00A F'tc :6.00
Rag . of 1 Otic T Tax Paid
Recorded In Official Records
County of Riverside
Gary L. Orso
Assossor, County Clerk. & Recorder
II1IIlE11
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I M b' J P?. 513E DP, 7ti i p
f i
GRANT DEED
NOC.R SNF
MiSC.
Re}vem ? CM EXAM
S 1,
8i 34*=IE839'?
, and.
FOR A Vh.LUABLB CONSIDERATION, receipt o:: which is hereby acknowledged,
JUDD MARN:OR, TRUSTEE OF THE MARMOit. REVOCABLE TRUST DATED APRIL 25, 1986 and JUDD MA MOR,
A WIDOWEF.
Hereby GFANT (S) to
ROBERT B. KELLOGG and SYLVIA KELLOGG, husband and wife as joint tenants MA CONTEMPORARY
HOMES
the real property in the City of LJ QUINTA, County of Riverside, State of California,
described as:
Lots 6 and 7 in Block 253 and. Lots 8
Unit No. 24, Santa Carmelite at Vale
19, Page;; 44 and 45 of Maps, records
Dated irlgust 18, 1999
State of Ca.l,iforn
County of '5
On
before ma,
through 14, inclusive in Block 265 of
La Quinta, as sown by Mao on file in Book
of Riverside Cour. a:Yifoarnia
} S.S.
VERL.Y wociYs
_lchl� C] 74=T ok_
personally known to me (or proved to me on
the basis of satisfactory evidence) to be
the person(y4 whose name') isAaTt subscribed
to the withininstrumen.t and acknowledged to
me that( she/they executed the same in
/herj X authorized capacity(te ), and
t by(he]:/thein: signatures`) on the
instrument the person('), or the entity upon
behalf cif which the Berson) acted, executed
the instrument.
WITNESS my hand d offic:i.
Signature
MAIL TA:C STA S TO:
rl j MA
MOR
USTEE
BEVY Vioo0S
Corlmission A 1140750
Notary {SIG — capornin
LOG A'geles County
MY Comm. Exp res.i 22 203
(This area for official notarial seal)
g Ij V 0• 9 N C.L-_n O; f r''r,_L C7 AULg_A ;l d fl I N 1i �
L QC'b (C:; 1 •n .ion
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11111111IIIIIEIIII100III 01
Building
Address
c)14- Oct)
'edit 4 eePaditsaile
P.O. BOX 1504
p 78-495 CALLE TAMPICO
_Nig_ I\\ \t^112j,\)DLA QUINTA, CALIFORNIA 92253
Owner
47- \I I ,� T •�1� �-t
Mailing
Address
City
rwlf, A
Z`p Tel.
4)'11
Contractor
Address
4).( \')C :5K�i
PPLI
BUILDING: TYPE -CONST. OCC. GRP.
/
A.P. Number 7Lj-,2L/./. t)/t
Legal Description G07 P/ 1
Project Description
City
L4\ t1/4)-1 11
Zip,
C1140a.f"1-ZN
Stateif. 9 g1
& Classif.
Tel.
City'C� 1k1
Lic. #
Arch., Engr.,
Designer
SlieFt. tor,
No.
Stories
No. Dw. -�
Units
New Gy.- Add Qi Alter 0
Repair 0
Demolition 0
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S -DECLARATION
hereby affirm that 1 am licepedpunder provisions of Chapter 9 (commencing with Section
7000) 0 O visiionn 3 of the Bfuslness AA PPrlbfessions Code -and m rte se i n full fo/!_ce a d-
ef�ecL 1 / V ` I /y sr./'A Q �
SIGRALURE DATE
OWNER•BUILDER DECLARATION
I hereby of go)hat 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
Me 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 live hundred dollars (S500).
1-: 1, 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. I!, 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.)
111, as owner of the property, am exclusively contracting with licensed contractors to con•
strucl 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 I am exempt under Sec. B & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
r] Copy is filed with the city. 0 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 (5 100) 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: 1!, alter 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
fn/, C
a a
1-A 05
/4 4,7
pAIO
Estimated Valuation
PERMIT
DEC 0
AMOUNT
,ra
Plan Chk. Dep.
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 INSPECTOR
Issued by. Date _ Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
IIIIIIIIIIIIIIIIIIIII t 02
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 ,
Building & Safety as your correction list. Please attach additional explanations as necessary.
APPLICANT.
PROJECT
CORONEL CONSTRUCTION
54-450 Avenida Alavarado.
ADDRESS:
APN: 774-241-01.0'
LEGAL: LOT 14 , BLOCK 265 , UNIT 24 S.C. @ V.L.Q.
CK'D BY: Leslie Mouriquand 0
BIN NO:. CASE NO. 99-162 ..CHECK DATE: -q61
Inform the assigned Building plan checker .upon ..your ..assignment to this case. The CDD
Executive Secretary maintains a log book to track applications andassign case numbers.
REOUIRED ITEM •
Y I N I COMMENT/CORRECTION
•
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. �'nt�.f1•>73Q.II:d'Ty::rt..��i<`.,;,,�.`.;.i+:`•.�<a$::;::;::?��cC:obi'i9.`.:.::::`::.r>.;:,;�),•;>::::r.::2:`>hii:; •� �:`\,..\,.a
Case logged and number assigned
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
OTHER REQUIREMENTS:
APPROVED BY COMMUNITY DEVELOPMENT DEPT
BY DATE �1�EXHIBIT
CASE NO.
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.