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0106-006 (SFD)' LICENSED CONTRACTOR DECLARATION t 1 hereby affirm under penalty of perjury that I am licensed under provisions of >'Ghapter 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 Signature of Contractor OWNER -BUILDER DECLARATION I hereby.affirm under penalty of perjuohat 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). ( ) 1, 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 370Af 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. 9TATE FUND 131*403.0 -,(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, 'L.shall not employ. any person in any manner so as to become subject to the workers' compensation laws of Califor la, and agree that if I should become subject„to the workers' compensation pirovl' ions of Section 3700 of the Labor C�e(l.shall forthwith comply with tho�s� ra isions. Date. i 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,S'afety�n 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 cf 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 wit all City, and State laws relating to the building construction,' 'and `lieretiy auy orize representatives of this City to enter upon the above-mentioned props for spection purposes. kI-, gnature.Owner/Agent) Date' BUILDING PERMIT PERMT# .DATE VALUATION LOT. TRACT APN ADDRESSJOB'SITE � '0-*RvS SAGUARO 1.)'& &b�tQi-�.n 3 0b19 OWNER CONTRACTOR / DESIGNER / EN INFER . ;fC WG CCa131' tY.' 3 0 1. 51 Y70 AM MA DMoR13; AS . 51370 AVENIDABEIMUDAS LA STUATfA, CA 92,253 LA QUINTA CA 92253 (7 60)564-' 5 62 C BL0 6255 USE OF PERMIT EMU RN)JU0. Y ]Wfla moi? O SFO - PERA 'i' DOES NOT INCLUDE $LO: K VoiA.1..t„ P&GR. OR .0RN'ff:1xl.A*Y APPROACH. (99' U8U 0.3 " TIVIR PLAN) TUCT CONSi'YdUC I`10H 117G2 O 9F PORCIVPATIOI .4.09 .asp' GAR ADF, 40.0 917 + DMITO CORT OF CIGNUMXMON 20517M.93 FIRM= b%F, fFUI MUZY CaNSI'R'UCTIONFITE 101-000-4-18.0100 MIN PLAN CtHWK1 0`EfI 101-000409-1-1$ $551.170 ME DEPOSIT 101.0047-439-318 4220,60 PPtLf;:KANICEs L 1119E 101-000-421-000 $60400 :6'•l,i?"S"•`t'R%CAL FFA 101-000-420-000 $1;19,96 PLUP+RFIM M.S. 201-4000-419-000 $I.0.00, 9'3`RONO M{J' 101 F99 - R191D 1'01.00X -241-000 $10138 GPLA.Ofk4o ,102F• 101-000.423-000 $20.00 4:aWFLOPER IMPACT FEE x'4.907,00 PP.ECISR PLAN 109-000-441-345 �Yif0.08 f X�t�X t"`�D�► ' C(i.1'l:`110NI 1f►l+if9'Tt..f1 I8?f:: PRE-PAU) MS `k3,.i65.QLUS 4150,00 FP117J ITTEN 1ACTE NOW 1 8 21001 -.55.1 &4 _L",! j C'IiY OF LA UUiNIA Rt EIPTbAErtJtt-YL�LAa / B DAT FI ALE � -l Off—. INSPECTOR , �.� �% ��_.1 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings•O ( Ducts Slab Grade AKE Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap _� _ _ l r F.A.U. Framing �d ! 5f Compressor Insulation 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 �z=�!—Q 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 817 l� �� Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ �+ '1. O ( 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) 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 736920 B Date Signature of Contractor OWNER -BUILDER, DECLARATION 03/31 /2C 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, willAo.the work, and the structure is not intended or offered for sale (See 7044, Business &.Professionals Code). 0 a®s« ( ) I,`•as owner of the property, am .exclusively confr`acting with' licensed` contractors to construct'the project (Sec.- 7044, Business & Professionals Code). O I am exempt under Section , B&RC.% for this reason Date 'Signature of Owner'' f WORKER'S COMPENSATION DECLARATION I hereby ,'affirm under penalty of pertu y .one the following•;declarations: ( ) y;have-and will.maintain a certlflcate'of consent to self-insure*�for:workers' compensation; as' provided for'by Section 8700 of.the Labor Code, for: the performance of thie' work fdr which this permit Is Issued. ( =) l.have and.will maintain.workers'.:cornpensation insurance,.as required by Section 3700: of the Labor Gode;.for the performance of thework forwhich this permit is: issued. My workers't compensation insurance carrier & policy no.. are: Carrier: Policy No TfiJI R FUND Y., %(This'section -need not -be completed if the permit valuation is for $100.00, or, less). certify that in theperformance. of the work for which this permit is issued, lshall not employ any -person in any manner so as.to become•subject-to the workers' compensation laws, of California, and agree that-ih should become' subject to. the workers' compensation provisions of Section 3700 of'the Labor Code, I'shall forthwith-complywitfi those provisions: Date = 'Applicant Warning: Failure to secure Workers',Compensation coverage is unlawful and sfiall subjectan employer to; cnminal,penalties and civil fines 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. rnade 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 inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMITk DATE VALUATION LOT 0106-005 TRACT I.()` 7ai1:e0 1. ; JOB SITE ADDRESS B.�L APN SAG ARO D , . �,., x . 646-31.3-0 14 OWNER / t CONTRACTOR / DESIGNER / ENGINEER IVM. KELI:OCTG C0!rI_E'14QOk.AR HOMIES 5137 0 AVEINTI-DA BERVUE) :S k -.S 137 0 AVENI A BEIUV JDA i . LA QUAT', A CA 92253 L.A. QTJaTiA CA 9225-3 i760i564.19f2 CBL# 6255 USE OF PERMIT - .. _ git•� GLE �_4t.1f?7 . f' � �T.]F.T�T :1Ty �� SFE • PERMIT DIDE36 NOT INCLUDE BLOCK v,'A LL, POOL uR.DRPdEvV:-kY APPROACH, (w MALiBU #3 MASTER PL„tri) .,,� r IT r��r'•'nFC T � <T t � . i � TtcA.,: �?,.,,.RtIGAI:�'tr ..ibS.f16,;F .. PORCHIP_p TIO . 44.00 SF GARAG •• ... .. - E �'.C'.r?ST OF �'C7I`�''S ITIM.- O 1 J�;7.80,00 TTii' FF�� IA S5aYpT�IATE FEE ''��e6r CON4•j R11F.'!011 VER i � l •�l[1if 4! _�ot;if1 _ G 3af1,{:fe PLAN CHECK F- $551.'i0` FEE DEPt i ,SIT ii8i:•CI AINIGAL. EE - 101-000-42 x'000 "60.0 - Tr:t�tiE;v , - EE r• r. r-. ELEC- . PLUMBING FEE 101 _000-4119-000 16.00 f3TRO O) 11 TiO.ti:FEE-.ESIi 10'1 -000443' -000 $101118 GRADIN FEE t i-01 _00(_)_423 0100 DEVELOPER IMPACT FEE PRECISEPLAN 101-000-441-” 45 ¢ .130 SLt'�-TOEAL. CONSTRUC-1101a AND, PLAN" C=,�CK $3,565.04 LMS PF.E-PA.ID FEES • $450,00 T(iI t4i. EE ,,SFR' !+ € T}TiF I!?[i��J 53 ;315:04 RECEIPT DATE BY DATE FINALED INSPECTOR fn1 � V Building Address 1 Owner �/ P.O. BOX 1504 78-495 Ci4LLE TAMPICO �JLA QUINTA, CALIFORNIA 92253 Mailing iJ Q o J � III ' `I ' Address V I.J 1 City Zip Contractor Address State Ljc. ( & Classif. Arch., Engr., ` Designer J.- Address Tel. CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION I here Dy affirm that I am�fcensgd oder provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the/i sines and Professions Code, and my license is in full force and effect. t .S S"a�'� • fJ OWNER -BUILDER DECLARATION I hereby affirm 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 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). 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, Bufsness 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.) IA 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 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 n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it 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., U, 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 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 APPLICATION ONLY r1 . .DING: TYPE'COrNST. OCC. GRP. Number G'k� '"v� 3 Description r r t Description Sq. Ft.>/ �6 No. No. Dw. Size t� D Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ stimated Valuation PERMIT AMOUNT Plan Chk. Dep., 5O vv Plan Chk. Bal. Const. Mech. Electrical ' Plumbing S.M.I. Grading ` Driveway Enc. Infrastructure A4AV ;l TOTAL REMARKS Cl . 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 b+ P.O. Box 1504 78=495 CALLE TAMPICo 1 (7 6-0) 777-7000 Shining Brighter ThanEVer LA QUINTA, CALIFORNIA 922.53 FAX (760) 777-7101 June 4, 2002 Homeowner 78-645 Saguaro.:Drive s La Quinta, CA 92253` Dear Homeowner: Please be advised of an address change for the following ,structure. Tf e .structure formerly addressed °in_error as;78 655.Saguaro`D-nve,APN#.64'6-313-014, the construction for which building permit #0106;,006.. was issued,. will now be addressed as follows: 78-645 Saguaro Drive., Please note this change and contact medirectly at (760) 777-7019 if I may be of further assistance. s Thank you. Sincerely, Diane Aaker Building & Safety Department Desert Sands Unified,School Disirict - 47-950 Dune Palms Road Notice: La Quinta; CA 922.53- , Document CannottBe Duplicated 760=771=8515, CERTIFICATEOF COMPLIANCE Date 6/18/01 '' APN # =646-313-014 No. 22137 Jurisdiction 'wLa Quinta Owner NameMr. Kellogg `1.; Pe emit # 010:6-006 No. 78-)"55— Street Saguaro 'Dr. Log # City La Quinta Zip `' 92253 Study Area Tract # Lot # , L 14 .' Square Footage• 1768_ F Z + Type of Development Single Family'Residence ' Y No. of Units 1 Comments At the present time„ .the Desertt.Sands ' Unified School, Distract do`e's not collect, fees on garages/carports, covered patios/walkways, residential additions under. 500 square feet,;detached-accessory'strdct&es or replacement mobilehomes. It has been determined the above-named owner is exempt from payrr gAschool'-fees at this time; due to the following reason: EXEMPTION NOT=APPLICABLE This certifies that school facility fees imposed pursuant to° ',Goverment n, Code 53080 in the amount of 2.05 X 1,768 ror $ 3;624 40' the property,listed aboveyand that -,building permits and/or Certificates of -Occupancy Ifor. this square footage m this:piopo. d project may now be issued Fees Paid By CC / Uniori Bank of California - Macus Kellogg-: Telephone .. Name on,the check- By heckBy Dr. Doris Wilson. '' 4 Superintendent Fee collected /eaem ed by >�r Annette,Barlow_. Payment Received $3624.40 ''CheckNo: 7425475: Signature NOTICE: Pursuant ot'Assembly Bill 3081 (CHAP 549, sTATS.'1996) this will se'r've to notiy'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 i sssued or'on which they:are paw to the District(s) or to another public entity authodied to collect them on the District('s)(s') behalf, whichever is eadier.- ` Collector: Attach a copy -of county or city.plan check application formAo district copy -for all waivers. Embossed Original- Building Dept./Applicant. Copy - Applicant/Receipt Copy - Accounting ...... ............ --------- .... . ....... . ........ .. . ...... ......... .. .. . ....... 01/09/01 10: 25 FAX 17608049062 C0W)l0iAh)`E.ALTH TITLE' Z002 RECORDING REQUESTED BY:.. AND WHEN RECORDED MAIL THIS DECD AND, UNLESS OTHERWISE SHOWN BELOW, MAIL TAX STATEMENTS TO: William Thomals Buf Z`ir'L Power Brokers D.O. Box' 134, La Quinta, CA 92253 TV. W L-) fz . , and ide :SPACE ABOVE THIS LINS*,'FOR RECQRIDERIS USE The undersigned grant e. A. P ,646'=:31>3-01 or(s) d clire(s): Gr�nt-Zeed 4 Doc6rnentary transfer tax Is S ° . . * , s� xy)'6.rnputecl on full value Of prop er",�,,cbnveyed, or S- computed on fyll,value ldss valuq;:of lie'n's and encumbranc4s" remz`ining at time of sale I IJ FORA VALUABLE CONSIDERATION receipt ofl.which is,.herebyacknowl6jd6ed, BILL RILEY...., hereby GRANTS) to ROBERTKELLOGG &'-.T-HQ MAS2,-BUFFIN the real property in the City of,' -La Qu i r,. t a Ccii.nty of , ni.versiae State of Califomia,-describede's Lot 114 of. Block Un i c INI o -santa Caxinelir-ai"-.— .ale La Quinta, as per.map recorded in B.6ok gages ifaps,- Recor'ds of i-iver! County', Califo-rnq'a. Paled- May 12, 2001-* Sian.6ture of (aranlor Stale of'CalifC.-nia C.Ounly cr ),SS. On before me, BILL �..R 1L -E Y ,personally appeared - BILL 'RILEy- personally kncwn to me (or proved to me on the basis of satisfactory., evida6ce)Ao be the parson(s)- whose nenne(s) is/are subs'CrIbed "a the 2 within instrument and acknaMedged to me, that h6/shelthey executed the same in hisihe./their authorited capacity(iis'),--- and , that' by hIsiher/their signatures) on the Instrument the perso;),(0;',6r the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS rny hand and official seal. p MAIL TAX STATEMENTS TO, TV. W L-) fz . , and ide Certificate of Occupancy City. -of La Quin' ta B:uildn a -n Safet De artment �� - g v X ,p 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 wit the various ordinances Of the City regulating bui/dng,construction or use:. For -the fol%wing: BUILDING ADDRESS:* 78-645 SAGUARO DRIVE. POST IN A CONSPICUOUS PLACE Use Classification: SFD Bld"g., Permit No.: 0106-006 Occupancy Group: R -3,U-1 Type of Construction: VN Land Use Zone:. RM 17/1 J . Owner of Building: MR: KELLOG.s Address: 5.1=370 AVENIDA BERMUDAS City:' . LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 2-21-2002 Building Official POST IN A CONSPICUOUS PLACE