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0209-006 (SFD)4 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury thaf; 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. Licensed# T�Lic. Class Exp. Date 3e ire fy ,Date �� '� Signature of Contractor � r 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, i'sot intended or offered for sale (Sec. 7044, Business & Professionals Code);, n . ( ) 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: 1, O I'have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Jor by Section 3700 of the Labor Code, for the 1 performance of the work for which this permit is issued. `( ) I have and will maintain workers' compensation insurance, as required by 'S ce tion 37.00 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insuranc.5carner & policy no. are: Cartier ST A'p E RYND Policy No. I M408_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 II forthwith comply wit t'o provisions. Date: /DA`s%1 Applicant PI 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, 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) Dateell BUILDING PERMIT PERMIT # ; DATE VALUATION LOT TRACT JOB SITE, APN J,7 (�fiiLE ADDRESS 1.74311 � nt�SONO .773-214-022 OWNER, CONTRACTOR/DESIGNER/EN (NEER ;eLfi3C�Cbif31lf� A�' CM1";L`17ANYRAf2,1t' HOW, ki 51 70 AVMDA DERMUD.AS , C3ti `PA CA 92,254 LA, QUWrA. CA 92253 € 2.55 USE OF PERMIT 1.435 5Y. SFD. PXR1u11T /+?OES NOT R K.2:%EDE HlrOC 'WALL, POOL OR DfRMWAY APPROACH PORC HIPA'r IO 109.s?b' SP OAit&OFICARPORT 474,00 3F t numm"I Con (YF conf arca 'twm t3�3e�i54�.�9 C01,W,TRUC'I`It.)W ITM 101-000.418-00 PLAN CHI7,Ci!C NPS 1Ql�ffiiU�;s9-�l8 �995.1�! TEE MOSIT 101-000-439-318 42SO.04 N9L01lt NIC:ALFEE 101-0010-421-000 MECTR1C.AL FEE 101.000-420.000 Sri14.2i Pr..1r2 nrkaa ez, 2i)1-40€419-000 15 STROWO fIAOy: SOLI M R.F.9D1 101 -OW -'1241-000 98.8.9 crt agar d l r� 101-000-42M-000 C►)yVEL0PN R. I1+ PA& FISC 105.00 i'tdE:CISEYVLA f 2�fY-t (r 1� 45 1ti©.s�0 eIe AND -A�i%'. S,1-:"4 �10.67 Lru . SEP 1,7 2002.. TcaAL P� 4.YLiTr:t' °.4,z DUE -N Ow V1,M— 1611 tCITYOFLAQUINTA s : FINANCE DEPT. Ii RECEIPT DATE BY D T FIyyA / INSPE 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 _ G , _ Exhaust Fans O.K. to Wrap F.A.U. Framing'" l2 G12_ L Compressor Insulation a 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 j -�j3_ 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 Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS\ Temp. Power Pole U 2_ 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) Wil} COMMENTS: Comments Single Family Dwelling 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 1,435 S.F. or $3,070.90 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 - Mark Kellogg Check No. 7924699 Name on the check Telephone 760/832-4641 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen Signature R $3,070.90 55.55 Payment Recd - Over/Under 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 Distnctfs) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated - Embossed Original - Building Department/Applicant Copy.- Applicant/Receipt Copy -Accounting CERTIFICATE OF COMPLIANCE v�1�sc Desert Sands Unified School District 47950 Dune Palms Road �q�o Q BERMUDA DUNES r Cate 9/16/02. q La Quinta, CA 92253 Cn RANCHO MIRAGE d No. 23622 (760) 771-8515 {� INDIAN WELLS ti �,� PALM QUINTA y INDIO Q O 'Owner Kellogg/Buffin APN # 773-214-022 Address - Jurisdiction La Quinta City La'Quinta Zip 92253 Permit # 0209-006. Tract # BLK 2 Study Area Type Single Family Residence No. of Units 1 Lot # No. Street S.F. Lot # No. Street S.F. _ Unit 1 11 77430 Calle Sonora 1435 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 - Unit 4 Unit 9 Unit 5 Unit 10 Comments Single Family Dwelling 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 1,435 S.F. or $3,070.90 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 - Mark Kellogg Check No. 7924699 Name on the check Telephone 760/832-4641 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen Signature R $3,070.90 55.55 Payment Recd - Over/Under 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 Distnctfs) behalf, whichever is earlier. NOTICE: This Document NOT VALID if Duplicated - Embossed Original - Building Department/Applicant Copy.- Applicant/Receipt Copy -Accounting {Sep, 5. 2002 9:35AM 11111\\RECORDING.REQUESTED BY; THE ESCROW SOURCE, INC. AND WHEN.RECORDED MAIL TO: AND MAIL TAX 8TATEMENY TO: Order. No. R-212886-1 Escrow No. 02-3396-SASQ Parcel No, 773-214-022-0 SPACE ABOVE THIS LINE -FOR RECORDER'S USE a ,. GRANT DEED THE UNDERSIGNED GRANTOR(S) DECLARE(S) THAT DOCUMENTARY TRANSFER TAX IS i X computed on full value of property conveyed, or computed on full value less liens or encumbrances•remalning at the time -of sale. - unincorporated area: •X LA QUINTA, and FORA VALUABLE CONSIDERATION, receipt of which Is'hereby acknowledged, t - hereby GRANTS to ROBERT KELLOGG •,. the following described•real property in the County of RIVERSIDE, State of California: . PARCEL NUMBER 773-214-032-0 - . q LOT 11, IN BLOCK 2 OF SANTA CARMELITA'AT VALE LA QUINTA, UNIT NO. 1, ASSHOWN BY MAP ON FILE IN r BOOK 18, PAGE(S) 46 OF MAPS, RECORDS OF RIVERSIDE COUNTY, CALIFORNIA Date 'September 5, 2002 STATE OF CALIFORNIA } )S -S. -. COUNTY OF } On before me, the undersigned, a Notary Public in and for said County and State, - personally appeared personally known to me -(or proved to me on the basis of.satlsfactory evidence) to be. the persons) whose name(s) Is/are subscribed to the within Instrument and acknowledged to me that he/she/they,executed the•sam® in his/her/their authorized capaclty(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'"- } APtAPr-14 C 8ui. 2003 6:46AM Ar+ CONTE' VW (_ K C LLQ G� CATE OF FIELD VERIFICATION AND DIA No 1257 P- 1 �.ea C T9STING CF -41Z a 3 e 3 Sullder Name.. ale hone Plan Number alepho p gample Group Number v✓ rAA(fhng Signature a Sample House Number F1rm:.fC, SS®GI�ieS ' HERS Provider: e f'< lGrrS . 5tro®t.Aaar.m: 7&ala 18'x--mlFor.% 01-d4,, cltyistBcerzlp: L -V Ouihr COT 92253 Copies to: Builder, HERS Provider tjER"ATE9 COMPLIANCETEM NT The house was: PrTested ❑ Approved as part of sample testing, but was not tested Aa the HERS rater provldlnp dl inosllc testing and Haid verlflcatlon, I certify that the houses identified on this form co m ly with the dlegnoetic tested compliance requirements as checked on this term. Distribution system Is fully'ducted (i.e., does not use building cavities as plenums or platform returns inn lieu of ducts) Where cloth cloth backed, rubber adhesive duct tape is Installed, maetic and drewbands are used In combinallon with cloth backed, rubber adhesive duct tape to seal leaks at duct connections, MINIMUM REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT Duct Diagnostic Leakage Testing Results (Maximum 604 Duct Leakage) { Maesured---- __.> Duct Prees.url?atlon_Test,Results,((;FM_Q.25.,Pa),--,: � . s :�., __ _.values_,.,- Test Leakage Flow In CFM If fan now Is calculated as 400cfm/ton x number or tons enter calculated value here If fan flow Is measured enter measured value here Leakage Percentage (100 x Test Leakage/Fan Flow) ® �� O Check Box for Pass or Fail (Pass -8% or less) ❑ Pass Fail jLl THERMOSTATIC EXPANSION VALVE (TXV) or Commission approved equivalent eyes ❑ No Thermostatic Expansion Valve (or Commission approved .. •'equivalent) Is Installed and Access its provided for Inspection Yee Is a pas* 042 a, Fail ❑ MINIMUM REQUIREMENTS FOR DUCT DESIGN COMPLIANCE CREDIT 1. 0 Yea ❑ No ACCA Manual D Design requirements have been met (rater has verified that actual Installation matches values In ,.� CF -1R and design on plan. 2. D Yes 13 No TXV Is Installed or Fan flow has been verified, If no TXV, k/' " ti =� verified fen flow matches design from CF -1 R. ' . Measured Fan Flow ❑ 0 Yes for both 1 and 2 is a Pass Pass -fail Nov 08 '02 18 05 FR TO 9-5686072 P.01/02 Inn fi�w47& odtrof .ToB On ` Engineering • CafsuWng • TbsOng .r REPORT OF FIELD COMPACTION TESTS ;1 TESTED FOR: CONTEMPORARY HOMES PROJECT: 77430 CALLE SONORA PO BOX 1141 1 LA QINTA, CA LA QUINTA„ CA 92253 DATE: November OS, 2002 OUR REPORT NO.: 073-20300-2 TEST DATA: (1) Coarse grained silty sand. OPT. MOIST.. = 8.0% TEST TESTSOIL ID IAB D �A TEST LOCATION: House pad. SE corner NE corner., NW corner Sw corner .MAXIM � COMMENTS• , RUMY 1. V/ATER WET DRY PERCENT Spec.. 90% Min NO. DEPTH ELEVATION NUMBER DENSITY CONTENT DENSITY DENSITY COMPACTION 1 8" FG 1 1 122.0 5.0 121.4 115.6 94.8 1 - A 2 8" FG 122-.0 X4.5 122'.6 117.3 118.41 96.1 1 - A 3 FG - 1 122.0 3.8 122.9 97.0 1 - A 4 8" FG 1 122.0 4.1 122.4 117.6 96.4 1 - A �... ---....... -_. ...- -- TEST LOCATION: House pad. SE corner NE corner., NW corner Sw corner 0 NOTES: TESTS PERFORMED PER ASTM D2922-96 8 ASTM 1330117-90", 'COMMENTS: A 1. FILL MATERIAL A. TEST RESULTS COMPLY yy�TH SPE�IFICATONS DENSITIE� SHOWN: Lbs. per Cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT COMPLY WATER C NT NT: Percent of Wei ht t 3. BASE COURSE WITH SPECIFICATIONS. PERCENT COMPACTION: BaseWon maximum dry 4, SUBBASE C. RETEST 0$ PREVIOUS TEST density obtained on sample indicated by j S. Il CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS soil 10 number. ! 6, OTHER E. MOISTURE BELOW SPECIFICATIONS * (1). ASTM.D1557-00 METHOD A 1 - TEST INSTRUMENT: STANDARD COUNT M: D: r REMARKS: ADJUSTMENT DATA M: D: Respectfully submitted, TECHNICIAN: Juan Nunez Professional Service Industries, Inc. i {tL• F 1 THEZE TEST RF -SULTS APPLY ONLY TO THE EPECFIC LOCATIONS NOTED AND MAY N0T RBPRG:ENT ANY OTHER LOCATIONS OR ELEVATIONS. ' REPO.MS MAY NOT BE REP�RCDVCEO, Q(CEPT IN FULL, WITHOUT WRITTEN DERMI^oS10N OT PRO/E.'IGONAL 6EItVICE INDUSTRIES, INC. - t PSI Ar100.2 (4)F Professional Service Industries, Inc. • 42.240 Green Way. Suite C • Palm Desert, one CA 92211 • Ph7601341-5790 • Fax 760/341-5794 Y' - •• . ! t 0 NOTES: TESTS PERFORMED PER ASTM D2922-96 8 ASTM 1330117-90", 'COMMENTS: A 1. FILL MATERIAL A. TEST RESULTS COMPLY yy�TH SPE�IFICATONS DENSITIE� SHOWN: Lbs. per Cubic foot 2. BACKFILL B. PERCENT COMPACTION DOES NOT COMPLY WATER C NT NT: Percent of Wei ht t 3. BASE COURSE WITH SPECIFICATIONS. PERCENT COMPACTION: BaseWon maximum dry 4, SUBBASE C. RETEST 0$ PREVIOUS TEST density obtained on sample indicated by j S. Il CEMENT D. MOISTURE IN EXCESS OF SPECIFICATIONS soil 10 number. ! 6, OTHER E. MOISTURE BELOW SPECIFICATIONS * (1). ASTM.D1557-00 METHOD A 1 - TEST INSTRUMENT: STANDARD COUNT M: D: r REMARKS: ADJUSTMENT DATA M: D: Respectfully submitted, TECHNICIAN: Juan Nunez Professional Service Industries, Inc. i {tL• F 1 THEZE TEST RF -SULTS APPLY ONLY TO THE EPECFIC LOCATIONS NOTED AND MAY N0T RBPRG:ENT ANY OTHER LOCATIONS OR ELEVATIONS. ' REPO.MS MAY NOT BE REP�RCDVCEO, Q(CEPT IN FULL, WITHOUT WRITTEN DERMI^oS10N OT PRO/E.'IGONAL 6EItVICE INDUSTRIES, INC. - t PSI Ar100.2 (4)F Professional Service Industries, Inc. • 42.240 Green Way. Suite C • Palm Desert, one CA 92211 • Ph7601341-5790 • Fax 760/341-5794 Y' - •• . 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: 77-430 CALLE SONORA Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0209-006 Occupancy Group: R-3 Type of, Construction: VN Land Use Zone: RC Owner of- Building: KELLOGG/BUFFIN Address: P.O. BOX 1 141 City: LA QUINTA, CA 92253 i� Building Official By: KIRK KIRKLAND Date: APRIL 15, 2003 'POST. IN A CONSPICUOUS PLACE ' n y