9911-171 (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 nd effect.
/ate
ense # Lic. Class Exp. Date /
7:,6'20 J3 0br9t?i2f
\ ` 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:
( ) 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 MEMPT Policy No.
(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
t6rkers' compensation laws of Cali rnia, and agree that if I should become
subject to the workers' compensatit pir;visions of Section 3700 of the Labor
Code --I all forthwith comply with { rovisions.
Date: ��� ° !4%j 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
con ruction, and hereby But h • rize Pepresentatives of this City to enter upon
th above-mentioned property for ins ectlon purposes.
Signature (Owner/Agent) J Date
0 BUILDING PERMIT PERMITk
DATE VALUATION LOT 9911-171 TRACT
,
SX2 ,29:3. 1 k+47,114
JOB SITE
APN
ADDRESS 51-3, 6 AVENMA RM10
77r�-045-W
OWNER CONTRACTOR / DESIGNER / EN (NEER
MRA&B ROIYJMT KF -U.000 CON7'EWNDRA sY. HOMES
47-7$5 VSA T''E'!'g 51370 AVINMAW—KRIAMDt S
LA QuWTA CA 92253 LA QUWTA ' CA 92253
(>60j5G4�19Fi2 Cl�1A# 6255 �
USE OF PERMIT . ,
a
WNGLE FAIMY 1±WL1'..LWO
,
SFD7 PF"I.T I O&9 NOT INCLU1DE f11.,OC);`WALL O.I POO1,. �
JUL 19. 2000
0
,
TRACT CONJTRIJOTION 2,017.00 9F
PORCHIPAX10 116.00 SF
0ARAWC.ARPO f (9F) MUM
5 FT. WOOD FZNCZ 200.00 LFP it
FS,S"lI'JJArKD COST" OF CORS'1'JtC1'G"&N 12:1,193.30
PERMrf INE SUMMARY
CONSTRUCTION FF;%: 101.000.419-000 $716."
PLAN CHECK N'E-E 101-000-439-318 $605.04
itrlk: HANICAL FEE 101 -000,421 -000 179.00
FS:LFet.'TRICIIL FIT 101-000-420-000 $142.70
PL11MBINO Fa 101-000-419.3300 $149.25
STIZONO MOTION FEE - RESID 101-000.241-C-00 $12.13
OIaAUINO FU 101.000-423.000 S2(l.09
°*
1 EVZLI)PER IMPACT NEE �1,9i?7.00
PRECISE PLAN 101.000.441=345 $100,o0
FEE 13EPOSI i' 101-000439-318 4250.00
.9, UD'.�t fAL CONWRUff- MOJzT AND PLA14 MFS`K $3,731.61
LF.;I,9 PRE -PAM FM -$250,00
TOT I P1ti R -w FRES DUE NONY ,4$1.61
•�
RECEIPT
DATE
B
A
DATE FINALED
INSPECTOR
INSPECTION RECORD
_ OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
=0v
_
S
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
--p p
g•7
Exhaust Fans
O.K. to Wrap
_ _ [
F.A.U.
Framing
!:jot
-t
Compressor
Insulation
- _ p
-r
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
d
5
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
_ -��O
S'7
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
o�
Utility Notice (Perm)
$j
7
P.O. BOX 1504
78-495 CALLE TAMPICO APPLI T N ONL
Building �� .���\� ;-�,11�11�
i Address � LA QUINTA, CALIFORNIA 92253
Owner �t II
BUILDING: TYPE'CONST. OCC. GRP.
Mailing /��
Address '� "� �� .-il A.P. Number -7Z5' t ^ LJy - R 2
City Zip Tel. s
Legal Description)'
Contra`cfor_ j Project Description iia n mL) 4 i_ n rA I i j-
ir Adress
—� .
Zip Tel.
Slate Llc. Crty
8 Classif�0'f'Z/� � �---� Lic. �A'�—� Sq. Ft. No.� No. Dw.
Arch., Engr.,�/CvJ((�� Size Stories Units
Designer ` r Ne U. -/—Add ❑ Alter ❑ Repair ❑ Demolition ❑
Addres L i
City Zip /l�� State
11NUC. #
LICENSED CONTRACTOR'S DECLARATION
I heretoy 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. t
i
SIGNATURE 'a DATE
DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: fSec. 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 thealleged 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
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./
('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.)
t -i I 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
f7 Copy is filed with the city. O 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'($100) valuation
or less.)
I certify that in the performance of thip 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, 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
ateMailing Address
City, State, Zip
1
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
asn
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
Notice:
Document Cannot Be Duplicated
Date 7/19/00
No. 20746
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 773-045-007
Jurisdiction La Quinta
Owner NameMr/Mrs- Robert Kellogg
No. 51-320 Street Avenida Rubio
City La Quinta zip 92253
Permit #
Log #
Study Area
Tract # Lot # 11 Square Footage 2017
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 amcgqt-,6f4
2.05 X 2,017 or $ 4,134.85 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 ` y%
Fees Paid By cc Union Bank Telephone 564-1962 '`,.1`�.: '-
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sheryl Simmons Payment Received $4,134.85
Check No. 7019322
Signator
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will sone 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 an 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 Mom on the Distdct('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
Av- i,2o eaio
necelvep: 6/30/09 0:48PM; 7803413215 -r 760 584 26341 Page 2 '
JUN .30.1999 6:5iPM CC INWERLTN NO. 916 P.2/21
Commonwed'. Land Titie COMM
72855 Fred )A .Dr, Suita AS Palm maert CA 6p ,
Estui hated Buyer's Settlement statement
lss=W No.: 99,8784KC
Buyer: ROBERT KELLOGG and SYLVIA KELLOGG, husband and wife as joint tenants
Property: APN 773-045-007-5. LA QUINTA, CALIFORNIA 92253
Escrow Officer: Kelly Collier
Date: June 30, 1999
DEBIT CREDIT
TOTAL CONSIDERATION $47,000,00
050.13312.O00:FBO - Little Company of the nary Hospital 32,536.71
gIJFFIN 2,000.00
ESCROW FEES TITLE CHARGES
Settlement Charge
PCOR
RECORDING FEKS. TRANSFER TAXES
Record Grant Deed
RECEIPT DUE fROM BUYER
,25,00
00
2b.00
12,784.29
$47,321.00 S47,321.00
Ub/MbW 918:49:09/KC
l/I ZiEO'�N b£�Z-t90'09i! `-3HOH, N60:Z 6661 '91'AON
I
0
0
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 the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
SITE ADDRESS
51=320'Avenida Rubio
ApN 773 - 045 - 007 BIN NO.: CASE NO.: 2000-264
LEGAL: LOT 11 BLOCK '47 7 UNIT 4 S.C.@V.L.Q
'
CHECKED BY: Fred Baker DATE:
Inform the as 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 IN
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as applicable
MDG filing required (5 filings since 9/3/98).
APPROVED 8Y COM UNITY DEVELOPMENM T
CASE NO.
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other Requirements:
f
gvatempvzauy. Womed
Post Dffa;e Box 1141..
-`ILa d,iiL1141
ina,CA 925
t (76 (760)563
May 19, 2000 _
City of La Quinta -
{ Building and Safety Dept.
Post Office Box 1504
'La Quinta, CA 92253
RE: Plan Check for 51-320 Avenida Rubio
To Whom It May Concern:
Please be advised that as owner of the above property, I have elected to build the project- .
under my General Contractors License number 736920. Accordingly, please remove
Coronel Construction from the Permit Application. -
i
Thank you for your attention:
Sincerely, -
Contem orary Homes
Robert B. Kellogg
!
Certificate bf Occupancy
1. City of La Quintal
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: 51-320 AVENIDA RUBIO
Use Classification: SFD,
Occupancy Group: R-3. Type of Construction: VN
Owner of Building: MR/MRS ROBERT KELLOGG
Building Official
Bldg. Permit No.: 9911-171
Land Use Zone: RC
Address: 47-785 VIA TRIESTE
City: LA QUINTA, CA 92253
By: STEVE TRAXEL.
Date: 08-28-01
POST IN A CONSPICUOUS PLACE
xavier urbina architect D
4986 paseo segovia irvine, ca. (949) 8560706
j .
June 9, 2000
City of La Quints
Dept. of Building and Safety
78495 Calle Tampico
La Guinte, Ca. 92253
Project: Plan HA
51-320 Avenida Rubio
re: Truss calculation review
Gentlemen,
A copy of the buss calculations has been submitted for review. The package consists of buss
engineering calculations, buss configurations, and buss 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
xavier urbina architect
4986 paseo segovia irvine, calif. 92612 (949) 856-0706
December 31, 2000 S!. 320 _ ,P Yo
City of La Quinta
C/oContemporary Homes
P.O. Box 1141 .
La Quinta, Calif. 92253
Re: Certification Plan HA
To whom it may concern,
Upon visiting the Hacienda Adobe house I observed the following discrepancies:
1. Numerous locations requiring anchor bolts within 9" of the end of sill'
plates.
2. Top plate at southwest corner of garage needs a strap where the
plumbing vent line penetrates through the roof.
3. Trusses need plywood on exterior surface within the truss space above
the top plate to top chord at bearing walls; and also need cross
bridging at center spans where shown on the drawings.
4. OSB board was not to be used, but it appears the structural values are
acceptable for the seismic and wind loading. OSB board will be
accepted in this house.
Please see that these conditions are remedied before proceeding with closing of
walls.
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.
R spectfully
avier Urbina
Architect
06/30/2000 14:34 7148560706 F .'. •DEBBIE URBINA PAGE 02
Xwer urbins architect
4986 pmo sWvie Irvine, ca. _ (W) 8560706 ;
June W, 2LM.7 * :
C4 of La OuinCe i
Dept. of Building and Safety j
78495 Calle Tampico
La tuinta, Ca. 92253 .
Project: Plan HA ' 4
51-M Avenida Rubes
re: Top Plate Lop Nailing
Gentlemen, t
Pleae note that the neding fir the double 2x4 top plate at the taps may be done awing to
the LIBC nailing schedule (Table 234&1) requirements of (B)16d nab each side of lap. The
forces due to wind or seismic actib'rty are not aures m, and therefore do not require special
nailing.
%we feel free to call U you have any questions or concerns.
Respectlully y ;
Xavier urbina-
Achima '
-. ,u • }• -.j • Tri. � ` ..