9907-159 (SFD)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
piN�1i1 i3 a �()Y
c
6Dat� l 1i Signature of Contractd or ? . -�
OWNER -BUILDER DECLARALN
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
1 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 Policy No.
"(.3G.rNI N, Ft6I,,:. ,CJS.
(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' compe sation"'provisions of -Section 3700 of the Labor
C, I shall forth!A h comply with th�6seGprovi ns
Oe� 1
tDat�! /— i Applicant T"1 --
Warning: Failure to secure Workers' Comp tion coverage is unlawful and
shall subject an employer to criminal penatties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to ,the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quints, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that l have read this application and state that the above information is
corrept. I agree to comply with all City, and State laws relating to the building
cor struction,-and hereby authorize representatives of this City to enter upon
purposes. @,
PERMIT #
BUILDING PERMIT
9907-159. ,
DATE + VALUATION$I I8 t,72 211 LOT I � TRACT
JOB'SI
ADDRESS -2tti t��rlLI�IDA C..tiRRANZ A,
A " 773-a5i-4Yi
l
OWNER
CONTRACTOR / DESIGNER / ENGINEER
arta sx ti40Q T)P1t',r��.
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t tr Yrr, ��r
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PILO BOX 399
i i _kiO � Thr Iv�i� vv'r ct :uiZ.
LA QUI t -A C'.'.A 47.253
LA QUI.N A CA 922.53
(7(-))564-16f)4 C11t1.11 2261
USE OF PERMIT
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f
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'z [�1�.0:,1' 4�i�ita 1..t�v�, i lGN i, yiEi.C3,t,•u•
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'z`9MA.;'f`N,ArtI'!rC+'�'d�A�•!'+('\T.r ➢'7-. liJ A""0'A!'iA.i
AJ 10.1,41. A1..t+U'V !•7 .k \: dA'./t• .,.3 \1\i'4A.t•
o,n 6+.
113�/94+P
yt•,�y �; �,s q�7y,.
RTNUT VLkRV
C't)RT:a:f'R.'U LION FEE 101-61041.9-0 0
KAN C? FCK fes: 1Ai I_My)-4.-in_;3t> gyy? gt
pw ,•a,t ',AY -lea• tr�9 Allo rA w+ r!+
\%;t1/'YA. f, •• FJVLIICAL FEE i 0..1 000? -420-060 S 14 39
:11:�,
�'� )VO tTEE 1.01-000-419-000 $13(mm)
ONn WYf'3ON I -U* - BERM 1111-fN►f)-NI-9011 $11 KC,
i _ f
1
10 Q{)0-4: ?I -0i10 :t•0
; e. ;
O..EVE C)PER i1ViF'ACT'FEE Si,go.w
PM-C;"ISE PLAN 101.0-00-441-345 �1,tt0.0U
? ! Ir
A RT TW Pl Jill -10 P1, ACFC - ttFS W 71151 -000.2 -%-u(XIn 4311
nWt.
WI.000•439—.31
�i7-?'f�'I;r1T,Cf:t�i'C1`Itf.tC°1'tc7 i a:NliPA?dC;Tf1'?C.'K
$3 74 61)
TOTAL PERMIT F VES OUR Ir ONY
&3,484.69
RECEIPT
DATE
BY .
D J F ALED
INSPECTOR
t
I,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Z
Return Air
Steel
Combustion Air
Roof Deck
a SCO
Exhaust Fans
O.K. to Wrap
if - j Fj- 04
F.A.U.
Framing
D- Zia
Compressor
Insulation�S
= 00
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final 1>%
BLOCKWALL APPROVALS
Final
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
/_ 7
Heater Final
Water Piping
Z(
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
/ ,� r 5
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
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
�� -f--�—�t���-:+.•+�..+.:tna.xti'^':-,:r��;.-.�:.- �sv-�^'�.-�.� w ..., >m-..-- rR- -.--v .- ,.. - i f.. :.y,... ...,.T,�.. - �.�-_.0-.. "�/"'..'S."'
w�
Building 5
Address ice•
Mailing
Address
City
0
tl�GN,rGv
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Y ?1 -t
ZipTel.
61,2.764 3 `
Cotract�or,,n ( _t...� j
Addpv,?
City Zlp oZ� TeL��ZbU
State Lic. / f City
& Classi �% (�" .�� 1; v) Lic. #
Arch., Erigr.,
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTTOR'S DECLARATION
�= (I`_hereh�firm that I am licensed under rovisiohs of`Chanfer G trn
with Section
gforge ap
••OWNER -BUILDER DECLARATION
4r I hereby affix hSI I am exempt from the Contractor's License Law for the following
,l+ 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
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
orimprovement 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 contractors) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. 8 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
n 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 (8100) 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, atter 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
thereby 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 slate laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned properly for inspection purposes.
Signature of a0plicant Date
Mailing Address
City, State, Zip
IILDING: TYP�•E'CONST. f OCC. GRP.
P. Number !� �t— t
gal Description (� J
^ t
oject Description
Sq. I. No.No. Dw. r'r*
Size Stories —11 Units
New Add O Alter ❑ Repair ❑ Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep. 2 5 d - C%0
Plan Chk. Bal.
Const. 1
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
l
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Si' a Street Setback from Center Line
h�Side tback from Property Line
FINAL DA3T�� � A ` —"'� INSPECTOR
�� j 4 -
Issued by: �� pat Permit
l� ��t.l e
Validate-06yet e �'r•''
,-0-'A
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
A
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: CORONEL CONSTRUCTION
PROJECT 51-240 Avenida Carranza
ADDRESS:
APN: _773-061-011
LEGAL: LOT 12 , BLOCK 73. , UNIT , S.C. @ V.L.Q.
CVD BY: Fred Baker
BIN NO:. CASE NO. 99-103 ..CHECK -DATE:
Inform. the assigned Building -plan -checker_.upori..-your assignment to this case. The CDD
Executive Secretary maintains a log book --to track -applications and assign case numbers.
REQUIRED ITEM
Y
N I
COMMENT/CORRECTION
:\•a.{:2{`,•,.:�`\\ n:.v:.: ..}\`:k.•r•�.
;w::k.^\t ,:;;,�\ti \:�:•:u.:::4ictiy:� \`\`�.•...)) .:.i �• t`\�Q:,�tC;� .�\\., ...; x•
:�\\t4.¢.\n:..:'J:n\.�:9�\}!v4\�.a,�v\k�:•'.`•4:0
RIM",
.V�.,���M.•�1r'���`�\�1#.:�:�:.�ivxy.,..,d:.�j`�C,�,•::::.�:::\:,...}.:...nThhv.vv,:,v.�..`v}.:.:i.;:..u...:..•.,":vv
\C_$,: ;f. .:<i<3J;`iii:^�n`:i'::i4:�: �A•M•\;�•'< "\\
;tQ t.y.. ; 4 ."`•%..\ t Y "ac:.''Y�
n,'i\:.�C �•: �h'ti+}.�'`ti' ♦.it.�.
C':J'•A, 1•::Cony...}..:��V�:•:}i'rn";ii:hi\.:"'J'i:h\'i:.iyf,'dr\4ti•:},v.,
..:.:.:...............:...•. ...TT�. .. A. �•.
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file las applicable)
APPROVED DEVELOPMENT DEPT.
MDG filing required 15 + filings since 9/3/98) 1 IfWAIT
Consistency -wiWstreet/surrounding area:. CASE NO,
Colors
Materialsa
Architecture
OTHER REQUIREMENTS:'
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.
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 1/24/00
No. 19948
APN # 773-061-011
Jurisdiction Palm Desert
Owner NameMr. & Mrs. Robert Kellogg
No. 51-240 street Avenida Carranza
city La Quinta zip 92253
Tract # B73, U9
Type of Development
Comments
Lot # 12
Single Family Residence
Permit # 9907-159
Log #
Study Area
Square Footage 1978
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 1,978 or $ 3,817.54 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/Hazany Coronel
Name on the check
Telephone
By Dr. Doris Wilson -
Superintendent
Fee collected /exempted by Mary Ann L. Borja Payment Received $3,817.54
Check No. 6529002
Signature
&.A -
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
abovewill 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 Distdct('s)(s') behalf, whichever is earlier.
t
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..0c.c-upancy
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-bui/ding construction .or use. For the following.,
BUILDING ADDRESS: 51-240 AVENIDA CARRANZA
Use Classification: . SFD- Bldg. Permit No.: 9907-159
Occupancy Group: R 3 Type of Construction: VN . Land Use Zone: RC
Owner of Building: MR. & MRS.. ROBERT KELLOGG
.Building Official
Address:
P.O. BOX 389
City:
LA QUINTA, CA 92253
By:
STEVE TRAXEL
Date:
11-06-00
POST IN A CONSPICUOUS PLACE