0208-266 (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
7.3,45M. B 03/31/2(
f
Date 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 underpenalty 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:
Cartier S)Tl• TE 1t)N1:) Policy No. 19":640-2002
(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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply withi ose provisions.
Date:
Warning: Failure to secure W rkers' 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.%,Jo the conditions and restrictions set forth o 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 6ff 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 repr§.sentatives of this City to enter upon
the above-mentioned property fro inspection purposes.
Signature (Owner/Agent) Date v ,;7
BUILDING PERMIT PERMIT#
ftDLd--lvTt;
DATE f VALUATION LOT TRACT BLK 66 iT6
JOB SITE ADDRESS 5A-. l{) J�a .ar#� .d a
APN 773-M-007
7
OWNER
CONTRACTOR/DESIGNER/EN (NEER
P.O. BOX 1 14)
5137 0 A1+.!'.+�T�.L A WiMMAS,
ia:ro, QT_T,%VfA CIA 92253
L,A:)LfWrA CA 922511)
(160)568-1404 MH 6255
USE OF PERMIT
MIME FA1vM1� I?VMLLJNq
1501 S.F. 511D. k'i.RMIT DOES NOT 11+ik,1..,UD,S B1,OC.K. WA.1,LZIPOOLS OR
TRACT CO;t+fS'1'RUCT'1ON 1,sv1.v sr,
POFtt^t•19faA`I IO 69,00 5r'
0AR-MMUC-A' i.T'ORT 46100 SIF
&SMIATMcosr or c0ns rmcnoN
iE'ERAM'i FEE SiMMARY
CON`f1'I RUCTION M 101.000.418.000 1601.51
PLAN CHECK l tFl K4
ME DEPOSIT 101,000-439-318 • 250,011
ME;f.'.HA.% ICA L t;UE 101-000-421-000
1~ 1 ECTRIC`-AL FEF 101-000-420-000 20-000 $110.30
1'3.,LDM,BINO 9 101-(i )-413-000 n.i3
S'TFti7M] LOTION FREE - RESM 101.000.24.1-0030 M0
0JLkS.DJN0 FEE 101 -W0 -423 -OW V5.00
i�Ts'�iEwfleR IMPACT FEE W05100
PRINCISE PLAN 101-000-441-345 $i1 Of}m
LLihS d'"RY-41A.{.6/•.CuJ.tt S
4250.SIt7
fSEP 55 2002-v s,.1' T FIMS DUE NOW
WYOFLAQUINTA
FiNANCEDEPT.
M
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
Roof Deck
Exhaust Fans
O. K. to Wrap
2�
F.A.U.
Framing
`� , �j
Compressor
Insulation
2 � �
Vents _
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
=`fo p
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
Waste Lines ` — j
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
n–
Pool Cover
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)
%'.•` .. }. r^ ° •. 'y' s.7. e, • p •ii• 1v-_• �y` +'s.,Ts s.i:. .your. ..r•....,�xrys5r .ro. ; v'6 ya_. �8N1�y� •.yam .-,.-,..,yv.l , y .r
u�itrGv .
P.O. BOX 1504
APPLICATION ONLY
Building 76-495 CALLE TAMPICO'
Address ) ✓V (� �� rL:Z_ LA OUINTA, CALIFORNIA 92253
Owner
4C BUILDING: TYPE'CONST. OCC. GRP.
Mailing �/�
Address ' V� /i�r% A.P. Number 1 0 3 - ° -3
CityZip Tel. �- l
� •2 Legal Description 17Z If, ./
Contractors
j_ l Project Description
Address
City
BY:
Zip
Tel.
State Ljc.7
& Classif.
j
C� 2
City
LC.it
Arch., Engr., /
Designer L P4 C
Address
Tel.
CityI Zip I 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. 7031.5,8usiness 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 or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
1: 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.)
H 1, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
I I I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS" COMPENSATION DECLARATION
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 if the permit is for one hundred dollars ($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: If, 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
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 1 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
I4,
Sq. Ft. /1�/v No. No. Dw.
Size Xi " Stories Units
New ❑ Add O
,timated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Eric.
Infrastructure
TOTAL
REMARKS
Altercl Repair O Demolition O
r
3
lilt/
AMOUNT
2sv
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
CERTIFICATE OF COMPLIANCE ��1FIED
sc
Desert Sands Unified School District moo- 4
47950 Dune Palms Road Q BERMUDA DUNES r
RANCHO yr
Date 9/4/02 La Quinta, CA 92253 INDIAN WELLS'c�F
LM DESEW
No. 23569 (760) 771-8515 � LAQUINTA
4INDIQ
R
Q
Owner
Marc Kellogg
APN #
773-083-007
Address
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0208-266
Tract #
BLK 66 U6
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 18
51360 Avenida Ramirez 1501
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
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. 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 1,501 S.F. or $3,212.14 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 Of California - Marc Kellogg Check No. 7924604
Name on the check Telephone 760/8324641
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Monica Guillen $3,21"2.14
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
those 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
i
Ju1,26, 2002 9:33AM
\\\\\\\RECORDING REQUESTED BY:
THE ESCROW SOURCE, INC_
AND WHEN RECORDED MAIL TO:
AND MAIL TAX STATEMENT TO:
ROBERT KELLOGG-
P.O.
P.O. BOX 124
LA QUINTA, CA 92253
Order No. R-212838-1
Escrow No. 02 -3298 -SA
Parcel No. 773-083-007-3
J6 0.44
GRANT DEED
LINE FOR RECORDER'S USE
THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAX IS $44,00 and CITY $
X computed on full value of property conveyed, or
computed on full value less liens or encumbrances remaining at the time of sale.
unincorporated area: X LA QUINTA and
P. 1/3
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
JOSEPFf P. FFRRY, SUCCESSOR TRUSTEE OF THE MARGARET FRICKE 1.TVZNG TRUST ORIGINALLY CREATED
ON JULY 20, 1989 AND RESTATE.,.) ON JUNE 10, 1994,
hereby GRANTS to CONTEMPORARY HOMES, INC.
the following described real property in the County of RIVERSIDE, State of California:
PARCEL NUMBER 773-083-007-3
LOT 18 IN BLOCK 66 OF UNIT NO. 6 OF SANTA CARM>✓LITA AT VALE LA QUINTA, IN THE
COUNTY OF RIVERSIDE, STATE OF CALIFORNIA; AS PER MAI' RECORDED IN BOOK 18, PAGE 67 OF MAPS, IN
THE OFFICE OF THE COUNTY RECORDER OF SAID COUNTY AND STATE,
Date July 26, 2002
JOSEPH P. FERRY
SUCCESSOR TRUSTEE
STATE OF CALIFORNIA }
} S..S.
COUNTY OF }
On , before me, the undersigned, a Notary Public in and for said County and State,
personally appeared JOSEPH P. FERRY
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the Instrument the person(s), .or the entity upon behalf of
which the person(s) acted, executed the instrument.
WITNESS my hand and official seal.
Signature
,RC DISTRICT PLANNIN 01 REVIEW: FORM
This form is to be used -:by 1C.DD .staff�•:for review, of, siq#e.family dwellings in the. RC(Cove
Residential) District per Section 9.50.0W.bf the Zoning,j<Code Its purpose is to determine: 1)
that the, proposed housing..design does -not, duplicate th6_sam . e architectur . al°style of any house
within 200 feet of the applicant, and/or 2)"if ther6.is':a heed'for the applicant to file for Master
Design Guidelines. If the applicant does need t6..,file a. Master-,Qesign'Guideline, please transmit
this information t . o,the Building and. Safety
a iety beoditm ent aspart of your correction list. Please
attach additional explanations as nec-ess'ary.,.
APPLICANT Kel I Ogg /rf.Buffen
SITE ADDRESS: 51 -160 -Ramirez
APN 773 083 007-3 CASE NO.,: 2002-699
LEGAL: LOT 18 BLOCK 66. UNIT S.C;.@V.L.Q.
CHECK AND APPROVED BY: ,Marti n Maglaria DATE:
Inform the assigned. Building plan-c-heit44r -u o m
. pion' y",ur assignment to this case. The CDD
Executive Secretary maintains a iog bbo"k to track applications and assign case numbers.
REQUIRED ITEM
Y
'N
COMMENT/CORRECTION
Verify legal and A.PN.informa.tion
Consistent with.,-MDG.'on file (a s
applicable)
MDG filing required (5 filings,
since 9/3/98)'.
Architectural variety within, 200
feet of the surro6n*dihg area:
o #
A W
Md bIC
E3 PIh
ng hin "'. commission
Sy ------
)MM U "it 'Dev. DepL
Irnti
,
Pgag,
0
Architectural design. features
r -n -Wim.
w
- 1. . 7"-
-------
d 0dttlons
Other Requirements:
Certificate of Occupancy
City.of La uinta
,Ko*
141®
'!
Bu�ldin and Safet
Department C OFY
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 comp/lance with the various ordinances
a of the-Cit"y'regu/ating building construction or -use. For the fo/%wing:
BUILDING ADDRESS:. 51-360 AVENIDA RAMIREZ
Use Classification: SFD Bldg. Permit No.: .0208=266.
# ti
-Occupancy Group: !R-.3 U-1 Type of Construction: VN Land Use Zone: RC
a _
1 _
c Owner. of Building: CONTEMPORARY HOMES,. Address: 51.470 AVENIDA, BERMUDAS .
' Y City.: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date:` 3-26-2003
= Building Official
POST IN A CONSPICUOUS PLACE
MAMar.25- 2003 '8:07AM pnCONTEMPORARY c.zLa 6
No 1026 P- 1 G.02
CERTIFICATE OF FIELD VERIFICATION AND DIAGNOSTIC TESTING CF -4R
Project Tore �►3 /� �°�
1/— 3 0 /`�M1�C�7_ Date
Pro) ectAdQresr, l . _..+%�✓Y4�� 6�?^�
t3ulld®r Na e
Builder Contt Telephone Plan Number .
HERS el®r Tele hone 5ample:Group Number
3 / )3
C ng Signature to Sample House Number
irm:.�C. d-�srOeI ��
HERSProvider:
Street Address: n,:6zt, citylstete/Zlp; L4/ �L//r9� Gam' gZzs 3
Copies to; Builder. HERS Provider
HERS RATER COMP ATi'MANI
The houve was; gg Tested ❑. Approved as part of sample testing, but was not tested
As the HERS rotor providing dieAnostic tesdna End n.old :vvrl.noatlon, I Certify that the houses identified on this form
comm My with the diagnostic tested compliance requirements as ch66ked on this form.
stribution system Is fully ducted (I.e., does not.use building. cavities as plenums or platform returns in lieu
if,here
ducts)
cloth backed, rubber adhesive duos tape Is Installed, mastic and drawbends are used In combination
with cloth backed, rubbsr-adhesive duct tape to seal leaks at duct conn®cl('
MINIMUM REQUIREMENTS. FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Olapnoatlo Leakage Testing Results (Maximum 8% Duct Lotakege)
Dtrct Pressurization Test Results (CFM @ 25 Pa) Measured
values
Test'Leakage Flow In CFM
If fan flow Is calculated as 400cfm/ton x number of tons .enter
calculated. -value here ab
If fan flow is measured enter measured velue-here
a
Leakage Percentage 000 x Test Leakage/ran Flow) ;,
Check Box for Pass or Fall (POSOL-6% or less) ❑
Pass Fail
THERMOSTATIC EXPANSI
VALVE (TXV) or Commissio
valent
Yes . ❑ No Thermostatic Expansion Valve (or Commission approved
equivalono Is Installed and Access is provided for Ineptiction .
Yes is a pass
MINIMUM REQUIREMENTS 00R.DUCT DESIGN COMPLIANCE CREDIT
0 Yes O No RCCA Manual:D-besign.requ(rements,heVa been met
(rater•has veriflgd tht'if actual Uislalletlon matches values In
CF -1 R and design on,plan.
2. 0 Yes O No TXV Is Installed or Fan' -flow has been verified. If no TXV,
verified fan flow matches design from CF. 1R.
Measured Fen Flow o
D
9e 8 F®il
� O
Yes for both 1 and 2 is a Pasta Pass Fail