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0012-145 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury,fthat 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 Dates` '.+`�, Signature of Contractor -mow" 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 ofethe following declarations: ( ) I have and will maintairn 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 work4or 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 Policy No. 9XINK (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 Calif. nla, and agree that if I should become subject to the workers' compensation ro6ions of Section 3700 of the Labor Code. I shall fofhwith comply with-tyip ovisions. Date, - Applicant— Warning: pplicant 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. F . IMPORTANT Application is hereby made to the Director,�of Building%nd Safety for a permit subject to the conditions and restrictions set forth on his application. �y 1. Each person upon whose behalf this application is made & each persoA�' whose request and for whose benefit work is performed under or py�gt t .� any permit issued as a result of this applicaton agrees to, & shall, i6Td6r6�ifi & hold harmless the City of La Quinta, its officers, agents 40mployees. 2. Any permit issued as a result of this application becomesA if aYd W& jL, 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. IT 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 author representatives of this City to enter upon the above-mentioned property tr i section purposes. Signature (Owner/Agent) r Date ` 3 i BUILDING PERMIT PERMITN DATE VALUATION LOT TRACT A' eW 17 JOB SITE =ADDRESS IS 773,311-4002 OWNER CONTRACTOR/DESIGNER/EN (NEER ;%A C70114TA CA 92233 LA QUN A CA 9 253 (760)564-1W2 CKA0 6255 USE OF PERMIT arma F;%MI Y 3 mmm 3711.P;t°RMIT DOES NOT INCl,,U Di 11�7Ch'.'b�f:�4 E ;eft trxdf.2�tlelL" �X TRACT CONSTAUCTION sy b"CDRCi•I"IT113 11rd.G0 S a Mr. VIOOD RMCF, ,100.0© JAF 041) COPT OIF C0R ffr U(7r QPT r� may y ��gy p� q'� f,�, •{EUXUA Pk_'TM :f VER G7�1.iAVJ..@C9lisiill. PLAN CFM,K WE 1.x#1 -WO -439-31 8 $592.0t $''I:,a!t'i CDFIF0211' 101-000-4-394318 -3250,00 a�?IC:1s�rP.dl�"F.i,"E ?Q3-000. 211-000 $49.00 :_-.:RCTRJCAL".E' '101-000-420-000 %125A7 ?WhISINGFEE "01-000-419.000 Y4 t.fYff 101-000-423-000 DwELOPEP. P RR.0 1.SZ P.1411 f 101-000-441-345 XOID.ff{� 2001 WI.,=WJAL COXITRU� ��.�10WAND "PLfiW CITEXR.. $ 4,6:6.64 0, UU0 L&I13 pry-FAI FMI9 4250.00 TOM PAULM,I.T PIKIES D now 1 fr RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Q _J ��7• Underground Ducts Ducts Slab Grade _ y �I Return Air Steel _ Combustion Air Roof Deck Exhaust Fans O.K. to Wrapdip( 7r F.A.U. Framing 7=1a — b� "" Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 7_� Drywall -Int. Lath0 Z3f' S, Finalz%Y� _ Final POOLS - SPAS BLOCKWALL A6`PPROVALS 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 Water Piping _ /%�!T/ Heater Final Plumbing Final Plumbing Top Out r 6 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) �j Notice: Document Cannot Be Duplicated Date 2/23/01 No. 21697 Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253 760-771-8515 CERTIFICATE OF COMPLIANCE Owner NameContemporary Homes No. 52-760 street Avenida Montezuma city La Quinta APN# 773-311-002 Jurisdiction La Quinta Permit # 0012-145 Log # Zip 92253 Study Area Tract # BLK169U17 Lot # 25 Square Footage 1955 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 2.05 X 1,955 or $ 4,007.75 the property listed above and that building,(V permits and/or Certificates of Occupancy for this square footage in this proposed project may now be iisu6d Fees Paid By CC/Union Bank of California - Robert Kellogg Telephone;'b0-564-1962; Name on the check P Y Y By Dr. Doris Wilson Superintendent Fee collected /exempted by Annette Barlow v" w' Signature 4wal�6/4- Payment Received $4,007.75 Check No. 7231993 NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting ame),F, Oct -13-2000 09121M From-UMMONWEALTH LAND TITLE +7609413216 T-634 P.001/001 F-662 RECO"IN(i RRQUESTU Syl CHICAGO TITLE COMpM;y COMPANY i 99,9037KC 97056909 WHE31 RXCORDEp MZL THIS DRRD AM MAx7. TAX ZSSHOWN TO; WILLIAM THOMAS BUFF'IN �/0 pAct ABMTH s 6"a E>3 R1D S USE APX: 773-311-002 GRANT DEED The undersigned grantors) declare (a); Documentary transfer cux is ro erty conveyed, or (XXX) Computed. on full value of p F and (.,.) cospcordorncedll value les -9 lieA3 and encumbtAnces remaining st time a d e. ( ) Vn P City of FOR A VALUASLF =NS%DERhTjoN, receipt of which i9 hereby acknowledged, ROBERT KELLOOG and SYLV'IA,KELL000, husband and wife as joint ttnsnc$ dba Contemporary KOme3 hereby OP ANTS) to WILLIAM THOMAS SIUMN, an unmarried man dba La Quinta Partners II the real property in Che City of LA gUINTA, County of Riverside, State of Calii'orai.a, descrLbed as: recordedBincBooklok 919, Page(.9)11, Tract S&nta 19- 0 inclusive Ofmmep9a in thevale-La officceLofathe.Countymap itecardew of Said Ccmsr- peaed October 13, 2000 state of California County 02 before me-, . personally appsare8 personally known to for proved to me on the basis of Sae,iafaezory evidence) to be the perscn(s) whose name($) is/are subscribed to the within Instrument and acknowledged to me chat he/ene/they executed the same in • his/her/their autnorized capa►cxcy(ies), and that by his/her/their signature(s) on the instrument the perscn(s), or the entity upon behalf of which, the person(s) acted, executed the instrument. WITYESS my hand and official seal. signature KAIL TAX ST.%TZMWS To- WZLI•" THOM" BUBF= .; A M9'ON ROBERT KELLOGG SYLVIA KELLOGG (This area for official notarial Seal) SONCH 83M0j NVZG: 3 OOOZ 'U'100 •xavier urbina architect 0 4986 paseo segovia it Ane, ca. (949) 856-0706 June 9, 2000 City of Le Quints Dept. of Building and Safety 78495 Galls Tampico Le Quints, Ca. 92253 Project: Plan HA 51-320 Avenida Rubio re: Truss calculation review Gentlemen, A copy of the truss calculations has been submitted for review. The package consists of truss engineering calculations, truss configurations, and truss layout. The manufacturer is listed as The Truss Company of Banning, Calif. The truss design and layout is in conformance with the structural design and intent of the structural drawings and calculations. Please feel free to call if you have any questions or concerns. Respectfully Q�+�J Xavier Urbina Achitect xavier urbina architect n paseo segovia June 18, 2001 City of La Quinta C/o Contemporary Homes P.O. Box 1141 La Quinta, Calif. 92253 Re: Certification Plan HA C5.2=760sMontezuma—DL irvine, calif. 92612 To whom it may concern, The certification inspection conducted on June 9, 2001 for the above subject project showed no discrepancies in the construction of the structure. The exterior is ready to wrap and may be done at any time. It was observed, however, that anchors were added to the foundation plate where the original anchor bolts were left depressed too far into the concrete and do not have adequate thread count to receive the washer and nut. The replacement anchors need to develop 4500 lbs. withdrawal resistance. A pullout test (or torque test of 60 ft. lbs. if wedge anchors were used) is to be conducted by the owner through a testing lab. This is hereby an authorization for the City of La Quinta building inspector to inspect and accept the above stated corrections when completed according to code and construction documents. Please feel free to call if you have any questions. pectfully �� SES AR avier Urbina GD. Architect t acc.e. * No. 0-13333 7k A xavier urbina 4986 paseo segovia January 10, 2001 City Of La Quinta Dept. of Building and Safety 78495 Calle Tampico La Quinta, CA 92253 architect rvine, calif. 92 Project: Plan HA 52-760 Avenida Montezuma Re: Truss Calculation Review Gentlemen, A copy of the truss calculations has been submitted for review. The package consists of truss engineering calculations, truss configurations, and truss layout. The manufacturer is listed as The Truss Company of Banning, Calif. The truss design and layout are in conformance with the structural design and intent of the structural drawings and calculations. Please feel free to call if you have any questions R spectfully, avier Urbina Architect L xavier urbina architect ❑ 4986 paseo Segovia irvine, ca. (949] 856-0706 City of La Quints Dept. of Building and Safety 78495 Calle Tampico La Quints, Ca. 92253 Project: Plan HA A%MWAW •9 42-1&0 AV9,g(DA► MOMMIUg4 re: Truss calculation review Gentlemen, A copy of the truss calculations has been submitted for review. The package consists of truss engineering calculations, truss configurations, and truss layout. The manufacturer is listed,as The Truss Company of Banning, Calif. The truss design and layout is in conformance with the structural design and intent of the structural drawings and calculations. Please feel free to call if you have any questions or concerns. Respectfully Xavier Urbina Achitect PM%moi Information -7b Build On Engineering • ConsuRing • Testing CLIENT % a V--TVA_Q Q0 DATE Architect Engineer INSPECTION REPORT Contractor c �� Q e ��� IM -M -It S Page-1-of— INSPECTION age of_ PROJECT (Name) (AddresS) VV�att� 2%1`N\N REPORT NO. O') 3 - \' \M - 0 Building Permit No. Plan File No. Govt. Contract No. OSA or OSHPD # Other INSPECTION MAT'L SA PLING QTY MATERIAL DESCRIPTION INSPECTION CHECKLIST _OSHPD _Concrete Cylinders _ Rinf.: Rebar _ Plan & Specs —OSA _Cement _ Rinf.: W.W.F. _ Clearances —Specialty Mortar Samples _ Rinf.: Tendons _ Positions _Mechanical _Grout Samples _ Conc.: Mix #/psi _ Sizes —Electrical _Masonry Prisms _ Conc.: Mix #/psi _ Laps _ Future Continuity #/psi Roofing Masonry Block _ Conc.: Mix #/psi —Concrete _ Fireproofing _ Grout: Mix #/psi _ Consolidation Masonry _ Units (block or brick) _ Mortar: Type/psi _ Mortar Batching —Struct Steel Prestress Conc _Asphalt Concrete _ Roofing _ Units: Block _ Units: Brick _ Electrode Storage iC Torque Applied 4 Old _Pile Driving _ Reinf. Steel _ Steel _ H.S. Bolts _Fireproofing _Steel —Waterproofing _H.S. Bolts _ Metal Decking _Non -Destructive _Tendon (PT Strands) _ Electrodes —Soils Technician _ Other _ Fireproofing Batch Plant _K Bolt Pull -Out _Other _Other Other _ Corrective action required _ Corrections completed _ REMARKS S Q urt1 c N, -e \2 'E. '(J Q R kU VIV) (3 N.Nt v 0 lJ N -0 o.`\ \ o' C - LI S `( r CJ �`O V U`\- `( 6 l u Ar X I %AN\ swoop ASOCQ QSS, Q�tL �Gb� ra CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers the locations of the work inspected only and does not constitute engineering opin- ion or project control. INSPECTOR NAME ZSJ AN4SUN L CERT. NO. (Print Clearty) INSPECTOR SIGNATURE �— DATE— PSI-B-900-170(2) (' - Z1. r, - () 1 Certificate of Occupancy City of La Quinta Building and Safety Department 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: 52-760 AVENIDA MONTEZUMA Use Classification: SFD Bldg. Permit No.: 0012-145 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: . RC Owner of Building: CONTEMPORARY HOMES —r&4 t Building Official Address: 51-370 AVENIDA BERMUDAS City: LA QUINTA, CA 92253 By: RICHARD KIRKLAND Date: 03-20-02 POST IN A CONSPICUOUS PLACE