0304-056 (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
136!42tY D 3! 3 f �C?
Date Signature of Contractor C_
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 STATt FIRID Policy No. .076111DV-202
(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 shajl forthwith comply with those' provisions.
Date: +!'P`� `7 Applicant
Warning' Failure to secure Wore rs' 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 irJection purposes. /� D
Signature (Owner/Agent) , Date 41/ / ,1?
PERMIT #
BUILDING PERMIT
DATE I yVALUATIONi�.��Gj �,1j LOT i TRACT .
JOB SITE
ADDRESS — ):J .� 1. �i Ems. IgT. 61
APN 7733—"V40.2,',
OWNER
CONTRACTOR/DESIGNER /EN INEER
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4.1hQ131-WEA CIA 912253
1+AQe.�.14'1;A CA 9225
(760)5,58.1404 GEk* 1� rP'j5
USE OF PERMIT
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yt�
n
APR 1 �7 2 43 : .
C1 0
FIN -
RECEIPT
DATE
G/ o '1BY
_.
DE FINA D
`�
INSPECTO
,r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
V
Return Air
Steel
Combustion Air
Roof Deck
Q
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
-- -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
5-12-C33 Z7
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
— G' 03
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 Cf
Final
Utility Notice (Perm) -C7/—
COMMENTS:
Date
4/17/03
No.
24335
Owner
Robert Kellogg
Address
P O Box 1141
City
La Quinta Zip 92253
Tract #
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
APN #
Jurisdiction
Permit #
Study Area
No. of Units
o�'S F s o
Q BERMUDA DUNES r
CA) RANCHO MIRAGE (_I
INDIAN WELLS
PALM DESERT ,y
LA QUINTA
INDIO
® J
773-184-023
La Quinta
0304-056
1
Lot # No. Street S.F. Lot # No. Street S.F.
Unit 1 11 51965 Avenida Bermudas 1498 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 1,498 S.F. or $3,205.72 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 Caliofornia - Mark Kellogg Check No. 8264590
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon MCGilvrey $3,205.72 $0.00
Payment Recd Over/Under
Signaturejw"x
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
SEP -19-2003 07:35 AM
RTIFICATE OF
Project Title .
P
ulloer
Date /
Bullde Ner6a %
e Plan Number
P.02
CF -4R
J //Yr Lop/l7Ptl✓1 &C-lyI .:p / 04 —)_
HER Rater Te phone Sample Group Number
O
qlaL-7
rtifying, Signature at Sample House Number
4' Firm: tiTC. �/ SSOG/ e� _- HERS Provider: /G.4- A5;o'c/—i S
Street Address: 7 �L0 ,�ra��For� Cir•'�Le� Clty/State/Zip: Z#uie�1a" 69
Copies to: Builder, HERS Provider
HERS RATER C!QMP41ANCrz STATEMENT
The house was; 9 Tested ❑ Approved as part of sample testing, but was not tested
As the HERS rater providing diagnostic testing and field verification, I certify that the houses identified on this form
corn ly.with the diagnostic tested compliance requirements as checked on this form.
7 Distribution system is fully•ducted (i.e., does not use building cavities as plenums or platform returns In lieu
Cof ducts)
Where cloth backed, rubber adhesive duct tape is Installed, mastic and drawbands are used In combination
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections.
MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Dlagnostic Leakage Testing Results (Maximum 6% Duct Leakage)
Duct Pressurization Test Results (CFM @ 25 Pa)
Test Leakage Flow in CFM
If fan flow Is calculated as 400cfm/toh x number of tons enter
calculated value here
If fan flow is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) =
Check Box for Pass or Fail (Pass=6% or less)
o
8 THERMOSTATIC EXPANSION VALVE (TXV) or Commissi
Measured
values
equivalent
Yes ❑ No Thermostatic Expansion Valve (or Commission approved
equivalent) is Installed and Access Is provided for Inspection
Yes is a pass
MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT
1. 0 Yes O No ACCA Manual D Design requirements have been met
(rater has verified that actual installation matches values in
CF -1 R and design on plan.
2. C Yes O No TXV Is Installed or Fan flow has been verified, If no TXV,
verified fan flow matches design from CF -1 R.
Measured Fan Flow =
Yes for both 1 and 2 is a Pass
;2- ❑
Pass Fail
X ❑
Pass Fail
Pass Fail
;4r
I `�
CITY OF LA QUINTA
oFMOFr° f,BUILD.ING & SAFETY DEPARTMENT
i 777-7012
i INSPECTION REQUESTLINEI �
_
777-7153' E
KELLOGG
Owner
Contractor CONTEMPORARY HOMES
304-05
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MU G, L LICCES
ltxvE. A
JOB�D$RESS F ' `
D PE]:M17f.)ES NOT INCLUDE
B�+LOC�SKrF WALL, POOL 01,Z*. DRIVEWAY
APPROACH
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL/ GROUNDING - p�
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UVTILADOVE SIGNED
ROOF NAIL / PRE -ROOF i
OKAY TO WRAP 3
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION lK. /7 o5
• • •-1 AlIML•
SEPTIC ABANDONMENT
SEWER CONNECTIONy
SEPTIC / GREASE INTERCEPTOR /
F MASONRY INSPECTIONS
( FOOTINGS /STEEL
BOND BEAM
f POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLI ORKS DEPARTMENT
I COM I EVELOPMENT DEPT.
FINAL / PLETED
i
ARnvF APUNEWL,S DO NOT INCLUDE RIGHT TO
M
IMP%�; Information
/r ®To Build On
Engineering • Consulting • Testing
REPORT OF FIELD COMPACTION TESTS
TESTED FOR: CONTEMPORARY HOMES PROJECT: 51-965 AVENIDA BERMUDAS
PO BOX 1141 LA QUINTA, CA
LA QUINTA„ CA 92253
DATE:
April 30,
2003
OUR REPORT NO.: 073-30155-2
MAXIMUM
LAB DRY *
DENSITY
WATER
CONTENT
WET
DENSITY
DRY
DENSITY
TEST DATA:
(1) Medium
grained silty sand.
,OPT. MOIST. = 10.0%
TEST
NO.
TEST
DEPTH
ELEVATION
SOIL ID
NUMBER
MAXIMUM
LAB DRY *
DENSITY
WATER
CONTENT
WET
DENSITY
DRY
DENSITY
PERCENT
COMPACTION
COMMENTS'
Spec. 909; Min
•1
811
FG
1
116.0
10.3
118.1
107.1
92.3
1 - A
2
811
FG
1
116.0
10.8
117.4
106.0
91.4
1 - A
3
811
FG
1
116.0
11.0
119.0
107.2
92.4
1 - A'
4
811
FG
1
116.0
11.4
120.2
107.9
93.0
1 A
TEST LOCATION: House pad.
1
NE
corner of
pad
2
NW
corner of
pad
3
SW
corner of
pad
4
SE
corner of
pad
NOTES: TESTS PERFORMED PER ASTM D2922-96 8 ASTM D3017-96 *COMMENTS: .1. FILL MATERIAL A. TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES SHOWN: Lbs. per cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT COMPLY
WATER CONTENT; Percent of dry weight3. BASE COURSE WITH SPECIFICATIONS
PERCENT COMPACTION: Based on maximum dry 4. SUBBASE C. RETEST OF PREVIOUS TEST
density obtained on sample indicated by 5. SOIL CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS
soil ID number. 6. OTHER E. MOISTURE BELOW SPECIFICATIONS
* (1) ASTM D1557-00 METHOD A
TEST INSTRUMENT: STANDARD COUNT M: D:
REMARKS: PSI did not monitor the material placement. ADJUSTMENT DATA M: D:
Respectfully submitted,
TECHNICIAN: Juan Nunez Professional Service Industries, Inc.
THESE TEST RESULTS APPLY ONLY TO THE SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATIONS.
REPORTS MAY NOT BE REPRODUCED, EXCEPT IN FULL, WITHOUT WRITTEN PERMISSION BY PROFESSIONAL SERVICE INDUSTRIES, INC.
Professional Service Industries, Inc. • 42-240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 760/341-5790 • Fax 760/341-5794
PSI A-100-2 (4)F
' S- —4
c
Certificate of Occupancy
ot
JJ
IdcproRnnn�
cwt
G� OFT9� Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 51-965 AVENIDA BERMUDAS
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0304-056
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: ROBERT KELLOGG Address: P.O. BOX 1141
City, ST, ZIP: LA QUINTA, CA 92253
By: KIRK KIRKLAND
-�
Date: September 29, 2003
Building Official
POST IN A CONSPICUOUS PLACE