9907-160 (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`T'
rc
Vpate + � signature of Contractor� �
OWNER -BUILDER DECLAR��
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 th�.property. am PxnluSlvRly nnntrarting with lirangprl
contractors to constructthe 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.'
(y) 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.
t,(a1.I>Is"t� t':�':f;.�f.; :(�75, IN W?'C°14'x; 0=tip
(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, with ihose.provLts�ion
vDate: f 2 fir ` APPlicant' r. �.
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, indemnity
& 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 (O�g n"t) ti°''"A'4 C- "" Date—/
PERMIT#
BUILDING PERMIT
"1107460
DATE VALUATION .��%,{,(�Q� LOT 3 TRACT
ADDRESS` 3 }1�11eV AVE,OB SITE NIDAd1e1114'�.IRE�
APN
1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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S.-340 EISf %i -3OW ER Dk.
J_,A E,yi,;.0NTA CA 14225:1
LA QUliNTA C'A 92;?:5��
t'��Si�fu'f-�hQ�l C'13L,� ;}atal
USE OF PERMIT
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Si F3 - }'li'_ khA a' S.:40EAE N0 s I1ti'C UkJ Ji ,,OC ,! "WALT, Vii KA -1
PORfCFtrt°Xi,10 ..12/.00 Wit•'
t3+A b3t»fCol#"t-k1' 511.00 Sil,
f"Y. W(101)VC-INCE, ?00,00 LF
VSi 111tVu APD MS 01;t C ON' WIt.VC fION'
107.0 1".100
ii'�AtACI I ti [""0," i, S€)tV1MA)It1'
FP+, DPT081T I 1-0C)0 a39-318 - °� t �tti
0ON1,4 T RWI('r`0NT-'rf t+�f.flt}C1_illit?f1 �h ^. +
1"LAN C3If #.:'Ib L,U 101 ^00-139.'1g
16J ._(:h it X AL d 1 , t01-000-421-000 S4 /mu
L! E C /'1 I AL F),, 101.000-4.20-000 S139.26
PT 1141,1tWO 14 -IF
4G' [1: 10l C00 123 000
ilLMEl.iJl'L<'J&WACV PPE,
sPLAN 101-000-44)-34i
,JR-W)TA1.('0N� .g `p,,i g",71 ON AIN T) P1.A'. V.1 fi-C"1'
LESS PRE -11M"1) FEES
`1:2"0.0`l
TOTAi, Pi+:.RMIT F b. S IAI I+. N(3:iV
3,�d 11.14
RECEIPT
DATE
BY
D E L
INSPECTOR
T
f _A INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs7
Underground Ducts
Forms & Footings
1!0Ducts
Slab Grade
A-3416-
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
- W
Compressor
Insulation
-67R
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
o�
POOLS - SPAS
BLOCKWALL AP ROVALS
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
_ _
�� ��
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�p �'
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL
APPROVALS
Temp. Power Pole
- ap
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-.4»�y�...+v-`-'�F"Tim,r",,.ws�,.;c.��eM.r-"n.:.,.�?;.ri,'r�a�s..:..-v+C's--.;:k.:
Building
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f�u1Gt//�
C_3L
P.O. BOX 150478-495 CALLE TAMPICO APPICA Y
f 1C. �•y' e f LA QUINTA, CALIFORNIA 92253
-Mailing,
Address
0 1 a
City- Zip
Address
C'.ty '" Tel.
> GO b I _%�, Zip CJ 1, 3 �
State Lic. City
8 Classif. �! j Lic. # ;?1? 4 /
Arch., Engr., `
Designer
Address Tel.
City IZip IState#
LICENSED CONTRACTOR'S DECLARATION
lehereby affirm that 1 am licenseq under provisions of Cp#pter 9 (commencing with Section
7000) of Division 3 of the Busines9 nd Professiort�Code, nd m license is itt fulI4 rce and-
effect. „-'^i J Vf! \l/.�xgV'c...�' / t1
A .f
SIGNATURE ��� V �+-+-�' DATE
\1 OWNER -BUILDER DECLARATION
I hereb ,afjirm'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 thathe 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 (8500).
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
t 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.) -
I 11, 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.)
0 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
n 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 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: 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. r
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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address '
City, State, Zip �{
ILDING: TYPE'CONST. OCC. GRP.-
'. Number –Ij -7 L/ — 72- 9!5� —• 0 1 %
2'_
)al Description�'
4
ject Description
?4 �
�1 W
i?
ZOTom, BY:
Mi,';r p�Setbackances: ` t
tont Setback from Center Line
Rear Setback from Rear Prop. Line
�tS.; SStreAt Setback from Center Line
a5 de Setback from Property Line
fi NAL DATE INSPECTOR
4 t1
Issued by: 7N Date Permit
Validated,bv: --
' !�
Validation:.
o �✓
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Sq. Ft.)..� t
Size ( rG
No. .�] No. Dw. .�
Stories Units
New C7/ , Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
4. _2 5Q --
Plan Chk. Bal.
l
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
r
REMARKS
?4 �
�1 W
i?
ZOTom, BY:
Mi,';r p�Setbackances: ` t
tont Setback from Center Line
Rear Setback from Rear Prop. Line
�tS.; SStreAt Setback from Center Line
a5 de Setback from Property Line
fi NAL DATE INSPECTOR
4 t1
Issued by: 7N Date Permit
Validated,bv: --
' !�
Validation:.
o �✓
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515 '
CERTIFICATE OF COMPLIANCE
Date 12/13/99 APN #. ` 774-295-015
No. 19751 Jurisdiction La Quinta
Owner NameMr. & Mrs. Robert Kellogg R�rmit #
No, 54-805 Street Avenida Ramirez Log #
City La Quinta zip, 92253 ' Study Area,
Tract # Lot # Square Footage 1701
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 mbbilehomes.' It
has been determined the above-named owner is exempt from paying school fees at this time due to tte following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 it the amount of
1.93 X. ' 1,701 or $ 3,282.93 the property listed above and that 5uilding x
permits and/or Certificates of Occupancy for this square footage in this proposed project may now :)e issued - Qz- v zr-
Fees Paid B _#y f u
y CC/Union Bank of, California - Mr: Kellogg Telephone'' -5641962 f'
Name on the check
f
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Patino Payment Received $3s282!93�~`
Check No. 6528800 {
Signature t'
IOTICE: 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 orother payment identified
bove 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 a another public entity authorized to
ollect 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
01
Reec�t:. .:!..,.
CHICAGO i,11,"L CuMPANl
RECORDING REQUESTED BY:
CHICAGO TITLE COMPANY COMPANY
99.8423KC
NNIRRI�JS �� &D'
ROBERT B. KELLOGG:
DBA CONTEMPORARY HOMES
200 HARBOR DRIVE, UNIT 3802
SAN DIEGO, CA 92101
SPACE ABOVE THI
GRANT DEET)
095559
RECEIVED FOR RECORD .
AT 8:00 AM
MAR - 9 1999
Recazdad in ONM Rwaft
of RFwraWa County. Cawortda
Recorder
—LQ
Fees S
5 LI& FOR RECORDER'S
. 77LI-295-015--
0Z -0-v
The undersigned.grantor(s) declare(s):
Documentary transfer tax is $22.00
(XXX) Computed on full value of pro.�erty conveyed, or
( ) Computed on full value less liens and encumbrances remaining at time of sale.
( ) Unincorporated area: ( ) City of , and
FOR A VALUABLE CONSIDERATION, receipt of which�is hereby acknowledged,
WILLIAM R. RILEY, TRUSTEE OF THE WILLIAM R. RILEY TRUST (1990)
hereby GRANT(S) to
ROBERT B. KELLOGG. and SYLVIA .KELLOGG,
husband and wife as joint tenants DBA CONTEMPORARY HOMES
the real property in the City of LA QUINTA, County of Riverside, State of California,
described as:
LOT 3, BLOCK 310 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT 28, AS PER MAP
RECORDED IN BOOK 19, PAGE 59-60, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA ,
Dated February 6. 1999
State of California
County of Riverside } S.S.
On February 8, 1999
before me, Kelly Collier
, personally appeared
William R. Riley
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 W1111
`d f' ial seal.
Signat�� () V vkt-
MAIL TAX ST TEMEN S TO: SAME AS ABOVE
WILLIAM R. RILEY, RUSTEE
Y�11Y �OIIIE— R
^omrn.
1057217
r���r:ry,,,'KpitlS �'N.IFOR(!pq
mere►;_ Coutty
;yy Con!rn F4rvac Ma
28. 1999
(This area.for official notarial seal)
r ,
RC Distda - 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 applicabitity 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.
PROJECT53.
ADDRESS: 54-805 Avenida Ramirez.,
APN: 774-295-015 `
LEGAL: LOT 3 BLOCK 310 , UNIT 28 S.C. @ V.L.Q. ;
CK'[) BY: Fred Baker _•
'131N NO:';. CASE NO`. 99-102 ..CHECK -DATE:
- Inform' the--assigned-Building-plan-checker•-upon, _your_ assignment to this case. The CDD
Executive 'Secretary maintains a log -book tc track -applications= and -assign case -numbers..,
REQUIRED ITEM Y IN COMMENT/CORRECTION
,`•\. .{\ \$ \ n\\. : \ \moi `•:Cn C\\\
t4 : Y
NNE\::., .�.\,
:J N I OWN
V.': ..�,.:•.�#.:.:.:•vw� ;?::;:C\:�i4�``{:`\inlY••.��•vs0:'F.\'r.','•�i.v}x}S•i:::.•\'.v.v •}}:2
Case logged. and number assigned
Verify legal and APN information
Consistent with MDG on file las applicable)
AF.ROVED BYSOMMUNITY
MDG filing required 15 + filings since 9/3/98)41
E _ 7 _
Consistency with-street/surrounding area:.
Colors
Materials
Architecture
f
OTHER REQUIREMENTS: '
The zoning code', architectural and landscaping' manuals, and/or assigned inspector "should
be consulted where 'u certainties: arise. The completed checklist shall be maintained -in the
Building '& Safety address file.
RC1 Wce,rtjficate,� ofO
Qity, of La ui Q n toV
Building and SO& DepartMent.y
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 fol%wing:
BUILDING ADDRESS: 54-805 AVENI.DA RAMIREZ
Use Classification: SFD Bldg. Permit No.: 9907-160
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC
Owner of Building:.' MR. & MRS. ROBERT R --KELLOGG Address: P.O. BOX 389
City: LA QUINTA, CA .92253
By: STEVE TRAXEL
Date: 08-
31-00
'Building Official
POST IN A CONSPICUOUS PLACE