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0203-038 (SFD)it U) N W o => co f` W o Z Z'OO H _J .(-)(D Iw— a Z• N p N UCY) CL Q o�cc ,tea X W co O U. a 0) Nt. Z_ co 5 �a R 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 3:i5'� 7 f3 03M 11 2( Date ,. 1.. �Signature of Contracto~ 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 I 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 STAIS F-riN.):: Policy No. 11MR-220011 (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 wit th'ope rovisions: Date: � 7Allicant .7A Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safe;y for a permit subject to the conditions and restrictions set forth on lis application. 1. Each person upon whose behalf this application is made & each person whose request and for whose benefit work is performed under or pursuarit t any permit issued as a result of this applicaton agrees to, & shall, indefnhi & hold harmless the City of La Quinta, its officers, agents and employee 2. Any permit issued as a result of this application becomes null and void i work is not commenced within 180 days from date of issuance of su 1 permit, or cessation of work for 180 days will subject permit to cancellatio . I certify that I have read this application and state that the above information correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this .City to enter:.upon the above-mentioned property for i sp'ection purposes. Signature (Owner/Agen • Daie , y BUILDING PERMIT PERMIT# 0243-031 DATE VALUATION � � LOT ' TRACT T IX � AJOB SITE ADDRESS &$-325VEMDA .EY.��I��J.� AS APN 174-095.-016 OWNER CONTRACTOR/DESIGNER/EN (NEER PO FIQX 1141 51 TA, Q1 r3,T',A CA 92223 LA QVIWI-A CA. 92253 USE OF PERMIT pY�'dei't1aa��LN1rCIr%y2.��9.!W4.'�3cCaY�iyq u7 r��/{� Ts A1q 9 t Ct/ f ^gip apr�y��teQ: iSMID � P.&RRINAI8• t,7CaM NOT 1�i= *, /.19.M1.�1: X tl•�%+R"NU, i?fi 01, OR � RJ11 C+ r A 1� . APPROACH, 03 MAS'!'I* "MADRID SARU M', GA42.f•30irJCAF8.3.?0R.T 504.00 We 5 Fr. WOOD PROCE 2AM00 LF Ce,Xt4ST_qU1r,'1`10N FEE 101-000-418n000 MR. MAN CHIMIC M 101-000.439-1118 U. FRE D11P SIT 101 -000 -439 -VU ELECTR1CAL< F�%:. i 0) -000•420-000 U23.10 t LUM B1WO V R ? 01-000.4 i, 9-000 $1113.80 81' P3OHO i4i0110N FRE , 9981D 3 D 1.000••241.000 S i 1,1 St C31.i'i i?IN O M 101-000-4.2;3.0p0 $X ():f) Das"ilEWPER IMPACT M $1,907.00 1517. 13Z MAN 1.01, -000-A41 a- - GAIT. Ci�I11'±(a'.+!6e i' L,.t*iC"C.�,i,".�'=( 43 r" i� 7MAM 2 2 2002 1 J Aa AL 1,1a .r a= ERS IDUE ,NOW W,N11,94 CITYnF WRA RECEIPT DATE/ aw BY �' D INALED INSPECTO � INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 FootingsDucts Slab Grade Return Air Steel Combustion Air Roof Deck 02! O Z Exhaust Fans 0. K. to Wrap -40 L F.A.U. Framing - . co Z Compressor Insulation p Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath f Final Final d�� / BLOCKWALL APPROVALS POOLS - SPAS 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 7 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Z. o Z 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 Q -p Final - U� Utility Notice (Perm) 2 COMMENTS: J 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 SITE ADDRESS CONTEMPORARY HOMES 53-325 Avenida Bermudas APN 774 - 095 - 016 LEGAL: LOT CASE NO.: 2002-626 BLOCK CHECK AND APPROVED BY: Wally Nesbit UNIT 2 G (wig — (INITIALS) S.C.@V.L.Q. DATE: 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 Consistent with MDG on file (as applicable MDG filing required (5 filings since. 9/3/98) Architectural variety within 200 feet.of the surrounding area: Colors Materials .Architectural design features Other Rip CFC9ommisston 0 City Council Commu 't Dev Dept. 3 Initials Case No. -n 0 Exhibit Wi s Ce R3ov 7'� sv22Av-��i�/G1 o i Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 ,Document Cannot Be Duplicated 760-771-8515 Date 3/22/02 No. 23069 Owner NameKellogg/Buffen No. 53325 City La Quinta Tract # BLK215 Type of Development Comments CERTIFICATE OF COMPLIANCE street Avenida Bermudas Lot # 5 Single Family Residence APN # 774-095-016 Jurisdiction La Quinta Zip 92253 Square Footage Construction of Single Family Residence of 1846 sq. ft. Permit # 0203 -03 8 Log # Study Area 1846 No. of Units 1 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 amount of 2.14 X 1,846 or $ 3,950.44 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 - Marc Kellogg Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Crystal Scott Payment Received Telephone i; r � r �3 950 44 Check No. 7688791 Signature JOTICE: Pursuant to 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 or other 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 to 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 u 203.0 Building Address Owner -��-,r.y,rR,-..- ..vrw;�s{�r�`niii`ij��tfs:;;�'i%�'�ai"�E�'T�-�'rr'�-�.:i�-7jy'•;;-T:„�yn,:.�''��.i;�:.:-�:��j- �'. �.=`#r� P.O. BOX 1504 APPLICATION ONLY o�2 6,0/-M78-495 CALLE TAMPICO 4eo I;— �L� QUINTA, CALIFORNIA 92253 Mailing Address City// Zip Tel. /G /J -I,1,_ onlFaGtUf 7-, /-)1'axho0 Zip I Tel. State Lic.City & Classif. 3 ZU Arch., Engr., Designer Address Tel. BUILDING: TYPE'CONST. Y r OCC. GRP. A.P. Number Legal Description Project Description ) I/1r / G* (T -AL.- Sq. L.- Sq. Ft. �� O No. j No. Dw. Size Stories / Units I Newer Add ❑ Alter ❑ Repair ❑ Demolition ❑ CityI Zip I State I 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 Contractors 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'fts 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). lJ 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 contractorls) 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 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. cher 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. 1 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 Address City, State, Zip Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS 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 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: 53-325 AVEINDA BERMUDAS Use Classification: SFD Bldg. Permit No.: 0203-038 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC Owner of Building: KELLOGG/BUFFEN Jb4-X Building Official Address: CONTEMPORARY HOMES City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 9-20-02 POST IN A CONSPICUOUS PLACE