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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
736920 B , 03131/V
DateVVM61 1 Signature of Contractor M!'
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:
( ) 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 ST,,j Policy No 15? �f4;3-X IDI
(This section need not be completed if the permit vajuation 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' compensation ,.,p o.visions of Section 3700 of the Labor
Code, I shal fo hwith comply wl �,ttigae provisions.
Date: a� Applicant'' � o
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)""-✓'� Date7,/
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
'e 4, i 1 BU ' 47 U23
JOB SITE
ADDRESS 774Z? `AyJX AR(YEf{
APN
74-171,013
OWNER
CONTRACTOR/DESIGNER/ENGINEER
.Re.)D1s= XELT.0r4,\T 13UFF71 '
CON it :t&jURWf BOW'S
51370.f_VrA4SDAr,,,T''.Zid'0DAZ_
51370 A�i'.I UMA13�R�'Si.TDAU
LAQpw-TA CA. 9225:5
1..AQUIWA CA 91253
(760)568.1404 C13iX 6235
USE OF PERMIT
;MITO1AIC,9i W. INa
s
SPO � 1A)T I - P�:ftMIT DORS, Mar 114CI.,VV ;13L C:CK ALLS, POOL, SPA,
Oft D IVFWJIIY.IF.PROACH
1
TRACT C043TRi1CTION 1,435,00 8F
P(OItC11!P-Al elo 199,00 Ste
CITY OF
C*ARAQWCAPPORT 474,00
FINANCE DEPT.
X811MT6-D CWT OF �CON11,0MVIVION
CIONST}i,I2ctIO9+ Ma, 101-000-418--000 0N.50
PLAN CHECK FRY 101.000-4.39-318 $501,23
nE DEPOSIT 101-000-439-3115
MECHA:NI s1. L FEE 101-000-421-000 $66:.5tI
91AC"TRIV AL WE S 01 -WO-W-000 31 tib, 21
PLlAMBINU FEF 101-000-419-000 $1.70.00
8" f f W N 0 MOTION fit? R - URw1i7 101.000-2441-000 $8.07
CiI".AD1140 FFA 9.IJ`I.O 3-00Gi $15.00
WeifLOPER IMPACT ftE $1,907,00
PRECISE PLAN 101-000,441-315 'lGO.t30
SUB TC dAL'V.!�.d:l'7�.�1i.���.A�,s�d,F.+! Xa7.MB�r'.�Y'yLaT'lyi.A�
$3,,431r�:�Ngy3y
�LpgJ.'.,CSf:.�l,+yLy4q.
"f8' 50.00
TOMAL PMdff VMrS DTA NOW
$:+,AC3:1*I
RECEIPT
DATE/ I
BY' '0'
DATE FINALED
INSPECTO
PAI
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
c
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
- Q
Exhaust Fans
O.K. to Wrap
Z
F.A.U.
Framing
5 O
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 l(/ �•
-A,
Final
Final
—1
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
• Q - p
Electric Bond
Footings
_
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pansp/��
O.K. for Finish Plaster
Sewer Lateral
SOZ
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
2 �l
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) (-
ELECTRICAL APPROVALS
Temp. Power Pole Cj G
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)
�rt'r51'f"yi"jq'iJij "'ERr'7✓,ryp�y�y--�r�{ ""a„�f—^.�,.,s�.-1'N�,�p+'�_ o y
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_51011610-
P.O. BOX 1504 APPLICATION ONLY
Building�j 78-495 CALLE TAMPICO
Address 1 �3 -7 6,,; & �,�� LA OUINTA, CALIFORNIA 92253 D20(2? _ 042,
Owner f�
Mailing )) / lJ BUILDING: TYPE'CONST. OCC. GRP.
Address/6. // A.P. Number � � 7'
City j Zi P, ITel,.3
1 /n4 2
`� —�� G� Legal Description 1�
Contractor/ % s Project Description
n /�
Address
City Zip Tel.
State Lic.r�
& Classif.
��� f
S V
I City
Lic. fl
Arch., Engr.,^
Designer
ZP-
^ L
Address
Tel.
5(P4-1
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm 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).
C2 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
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.)
I 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.)
1-1 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
r7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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., H, after 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
Ihereby 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 slate 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 a0plicant Date
Mailing Address
City, State, Zip
Sq. Ft. / " 7 Sr No. No. Dw.
Size / Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O
Estimated Valuation / dj
PERMIT AMOUNT
7
Plan Chk. Dep. r i
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY: Y
Minimum Setback Distances: t
Front Setback from Center Line
Rear Setback from Rear Prop. LIM
Side Street Setback fr- enter
Side Setbai;Qkom Pro Ine
FINAL DATE �' SPECT
�yl
Issued by: D
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
'1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Contemporary Homes
SITE ADDRESS
77-837 Calle Arroba
APN 774 -171 -013 CASE NO.:
LEGAL: LOT 1
BLOCK 247
2002-652
UNIT
CHECK AND APPROVED BY: Greg Trousdell DATE:
S.C.@V.L.Q.
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
Verify legal and APN information C/
Consistent with MDG on file (as
applicable NAY 7,
MDG filing required (5 filings sinceeaNC�,y���
9/3/98)
Architectural variety within 200 feet of
the surrounding area:
b •'00
h
O Go J
IVO/
Architectural design eta 00
Other Requirements: O�
1
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
Date 7/16/02 La Quinta, CA 92253
No. 23382 (760) 771-8515
Owner
Robert Kellog
APN #
Address
51370 Avenida Bermudas
Jurisdiction
City
La Quinta Zip 92253
Permit #
Tract #
BLK247U23
Study Area
Type
Single Family Residence
No. of Units
q���1FIEDgc�o
.2 0
Q BERMUDA DUNES r
RANCHO MIRAGE
INDIAN WELLS
PALM DESERTLAQUIN,y
.�jQ INDIO TS^�
774-171-013
La Quinta
0206-042
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 1 77837 Calle Aeroba 1435 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 50
square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile home
It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,435 S.F. or $3,070.90 have been paid for 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 - Mark Kellog Check No. 7924331
ame on the cneCK Telephone 760/832-4641
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott $3,070.90
Payment Recd Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), 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 issued, or from the date on which thos
amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy -Accounting
RECORDING REQUESTED BY:
AND WHEN RECORDED MAIL THIS DEED AND,
UNLESS OTHERWISE SHOWN BELOW,
MAIL TAX STATEMENTS TO:
CONTEMPORARY HOMES
-7-7-05-7. .A iJ
SPACE ABOVE THIS LINE FOR RECORDER'S USE
1'h• undersigned grantor(s) declare(s), Grath Deed XPA 774-171-013-
Documentary transfer tax to S
( xx) computed on full value of property convoyed, or
( ) computed on full value less value of liens and. encumbrances remaining at time of sails,
( ) Unincorporated area; ( ) City of ; end .
FOR A VALUABLE CONSIDERATION, rocefpt of which Is hereby acknowledged,
BILL RILEY
hereby GRANT(S) to CONTEMPORARY HOMES
the real property In the City of La Quin Ca
Stale of California, described as
, County of Riverside
Lot 1 of Block 247- Unit No, Santa Carmelite. at Vale. La Quints,'
tse per map recorded in Book Pagaa mf Maps, Records of Riverside County,
California
Dated April 231 2002
slate of California )
County of
On before me,
,personally appeared
BILL RILEY
personally known to me. (or proved to me on the blasts of satlahaetofy
evidence) to be the person(&) whose neme(s) Is/ere subscribed to.the
wlthln Instrument ane acknowlodged to rr,e that he/she/they executed
the same In hi0edlhelr aulhorlt:ad eapacity(Ies), and then by .
h1alherAhelr signatures) an the Instrument the pereon(s), or the entity_
upon behalf of which the person(&) adod, executed the Inetnrment.
VVIYNESS my hantl and olnolel deal.
Signature
*Signature of -Grantor
BILL:RILEY
MAIL TAX STATEMENTS TO, fixe ac.aboV—
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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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction
77-837 CALLE ARROBA
Owner of Building: BUFFIN/KELLOGG
Building Official
vni
Bldg. Permit No.: 0206-042
Land Use Zone: RC
Address: 51-370 AVENIDA BERMUDAS
City: LA QUINTA, CA, 92253
By: KIRK KIRKLAND
Date: DECEMBER 13, 2002
POST IN A CONSPICUOUS PLACE
l
CITY OF LA QUINTA
BUILDJIG'& SAFETY DEPARTMENT
777-7012
iyY; INSPF„OTION REQUEST LINE
k` r 777-7153
Owner- (l RT KjRj,LoG\j BLTFFEN
Contractor- CONTEMPORARY HOMES
Permit Number 0206-042
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 77-837 CALLE ARROBA
SFD - LOT 16 - MASTER SAN FELIPE - PERMIT
DOES NOT INCLUDE BLOCK WALLS, POOL, SPA
OR DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
RARY POWER
;KS
-UMBING / WASTE
-ECTRICAL / GROUNDING
NGS/STEEL
RETE SLAB
RIM DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
NAIL/PRE-ROOF
TO WRAP - �y
FRAMING COMBINATION 62
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION �2
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH -
GAS TEST '2 -
SEPTIC ABANDONMENT
SEWER CONNECTION �Z
SEPTIC / GREASE INTERCEPTOR
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
MASONRY INSPECTIONS
FOOTINGS / STEEL
\,
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G dAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING / ..
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING