0307-045 (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
736920 B _ 03/3111
-Date
to 'i " Signature of Contractor
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 STAT•R FUND Policy No. I 08-2002
(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 those,provisions
Pate: j Applicant
Warning: /Failure to secure WorkersCompensation 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 thre 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 emplo
2. Any permit issued as a result of this application becomes null and
work is not commenced within 180 days from date of issuance of
permit, or cessation of work for 180 days will subject permit to cancell
I certify that I have read this application and state that the above informal[din
correct. I agree to comply with all City, and State laws relating to the bu
construction, and hereby authorize representatives of this City to enterthe above-mentioned property for inspection purposes.
iv
Signature (Owner/Ageryt) r Date
BUILDING PERMIT PERMIT# I
1t3-
DATE ' VALUATION '.... `LOT TRACT
JOB SITE / +
ADDRESS 77-745 CMXF.
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
BOB XMIOC
CON'T)EWORAU HOINMS
P.0, RUX 1141
5I370 AVWDDA1:iFUMMA'S
L&Qilfll+TA CA 92233
l:AQC.TLIdIrA CA 92253
.. .. 1.
q p ¢
(I60)5ih -140 ' 4.b7J.fi7' 6235
USE OF PERMIT
1514 S.F. sim'FeRm.rr L)oas NO'P INCL. mita � im wj,;4 PooLPSPA
OR Gl'i1VEWAY APPROACH
TRACT Ct3NSTRUCT10IN 1,$14.00 SF
'
POIZ'CH3d AT%O 176.00 SF
0ARAG ilC.ARPORT 536.00 3F
P%91 j: COSTP .O F CONb' XUCn0N
PhMUT 7 LIC SUA94 +RY
C(')NSTR,11CTI0N FEE 101-000.418-000, S631150
PLAN CHECK FEE 101-0030-439-318 $516.35
'
FEE DEPOSIT 101-000-434-318 -$250.00
MECHANICAL FFZ 101-000.421-000 $5150
1; EC` RIO',P.I.IEE 101-000.420,Q00 $112.21
PLUMBING FEE 101-000-419-000
ST RONO MOT ION ME - R.,SIO 80.51
.101.-000-241-000
L1t�:Ai7I1�i1 PUrI; ItII-Qua-el'�3-0(20 $15.aQ
•
D'EVELOPSK IMPACT FEE,�2,40l.08
PRECISEPLAN 101_000.441-s45
SUB -W TA% CO) WRTJ C710N AND PLAN CHECK K
$3,930, 27
Lis M-�PAID r
4250.00
-- IDTAXIMIMAW—TRESPUE NOW.
$3,70627
JUL 01; 1003.
ITY OF LA QUINTA: �--
FINANCE OEM_
RECEIPT
DATE Y ,
BY
DAT AL
INSPECT
F.
� ti•:.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A
Ducts
Slab Grade
owReturn
Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
2. �d
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
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
I
Gas Piping
PLUMBINg
APPROVALS
Gas Test
Electric Final
Waste Lines $
_
_Q
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection /D d3
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
Final
Utility Notice (Perm) tit
COMMENTS:
`AivO�(i.K9/,t� A4f4W&l/ ~ IV 1AW10.0" /Q6w/IaY!
e4#*v� 4r- 4YZW '✓ 1-�A14 -f
S,q,�,fusa/,6�p�ilCiol�iaa>r' ,�(�
Comments Certs #24670 through 24672 used for CC#8370766 in the amount of $10,081.54
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 1,514 S.F. or $3,239.96 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 - Marc Kellogg Check No.
Name on the check Telephone 8370766
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey Payment Recd g0.Oo
$3,239.96 Over/under
Signature
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 whist,
those amounts are paid to the District(s) or to another public entity authorized to collect them on the Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
CERTIFICATE OF COMPLIANCE
�Fsc
Desert Sands Unified School District
47950 Dune Palms Road
z4�c�o
Q BERMUDA DUNES r
Date
7/7/03
La Quinta, CA 92253
RANCHO MIRAGE d
No.
24672
(760) 771-8515
WELLS
�J INDIM DESERT ti
PALM DESERT y
LA QU
10-�INDIO
yJ
O J
Owner
Bob Kellogg
APN #
773-265-012
Address
P O Box 1141
Jurisdiction
La Quinta
City
La Quinta Zip 92253
Permit #
0307-045
Tract #
BLK 98
Study Area .
Type
Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 1
77745 Calle Sonora
1514 Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments Certs #24670 through 24672 used for CC#8370766 in the amount of $10,081.54
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 1,514 S.F. or $3,239.96 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 - Marc Kellogg Check No.
Name on the check Telephone 8370766
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Sharon McGilvrey Payment Recd g0.Oo
$3,239.96 Over/under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period'in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on whist,
those amounts are paid to the District(s) or to another public entity authorized to collect them on the Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
Oct.10. 2003 1:37AM CONTEMPORARY
�i Information
.ToBuzld On
4ngineering . Consulting . resting
No.3046 P- 3
REPORT OF FIELD COMPACTION TESTS
TESTED 1=0R: CONTEMP012ARY >,' OMES PROJECT'' 1_37_7 45-AVE-SONORA
• PO BOX 1141 d' LA QUINTA, CA
LA QUINTA, , CA`92253 '
DATE: July 15, 2003 OUR REPORT NO.: 073-30283-2
TEST DATA: (1) Very fine grained silty sand. OPT. MOIST, = 11.0*
"1
8.1,
FG
2
811
FG
3
811
FG
4
-811
) G
IATION
'NUMBER
MAXIMUM
ENSITY *
CONTENT
DENSITY
COMMENTS*
Spec. 90$ Min
DENSITY
COMPACTION
—
1
118.0
_
4.1
121.3
116.5
a
98.7
1 - A
1
118.0
3.7
122.2
117.8
99.8
1 - A
1
118.0
4.4
120.1
115.0
; 97.5
1 - A
1
118.0
4.0
121.8
117.1
99.2
1.- A
'EST LOCATION: House pad 77-745 Ave Sonora
1 NE Corner
2 SE corner
3 SW Corner
4 NW Corner
r r .
DTES: TESTS PERFORMED PER ASTM D2922-90 & ASTM D3017-96 *COMMENTS-- 1, FILL MATERIAL- ' A.',TEST RESULTS COMPLY WITH SPECIFICATIONS
DENSITIES SHOWN; Lbs. per cubic toot 2: BACKFILL • Bi PERCENT. CCpp PACTION DOES NOT COMPLY
WATER ONT6NT: Percent ofd weight 3. BASE COURSE WITH SPSCIFICATIONS
PERCEN CO0MPACTION: Base o0 maxlmum dry 4. SUBBASE , C. RETEST P PREVIOUS TEST
density obleined on sample Indicated by S. SOIL CEMENT D. MOISTURE IN EXCEzS�S F SPECIFICATIONS
soft ID number. 8, OTHER E. MOISTURE BELOW 5SI'E�IFICATIONS
* (1) ASTM D1557-00 METHOD A _
:ST INSTRUMENT: STANDARD COUNT M: I D:
EMARKS: • PSI did not monitor the material placement. ' � �, •:ADJUSTMENT DATA M: � . p;
.W We,spectfuliy submitted,
TECHNICIAN: Juan Nunez Professional Service Industries, Inc.
EeE TEST RESULTS APPLY ONLY TO THe SPECIFIC LOCATION& NOTEO ANO MAY NOT REPRESENT ANY OTHER LOCATIONS OR ELEVATION6.' Y+� I `• •`F..
PORTS MAY NOT BE REPRODUCED. EXCEPT IN FULL, WITHOUT WRITTEN PERMISSION DY PROFES81ONAL SERVICE INDUSTRIES, INC. ..
A,100-2 (4)F Professional Service Induslrles,'Inc. • 42-240 Green Way, Sulte C • Palm Desert,'CA 9,,2}211 Phone 760/341-5790joFax 760/341•=5794; X;
Certificate: of0ccU ancPY
low1
-Buildirng & Safety. Department
This Certificateis 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: 77-745 CALLE SONORA
Use classification: SINGLE. FAMILY'DWELLING-Building.Permit•No.:0307-045
Occupancy Group R-3 Type of Construction: V -N Land Use Zone: RC
. _.�_ __ _ Address: P.O. BOX -
1141,. - -
�Owner of'Building: BOB KELLOGG j`
City, ST, ZIP:.LA QUINTA.CA 92253
By: KIRK KIRKLAND
Date 05-03-2004
- ,Building Official _
' POST IN A CONSPICUOUS PLACE