0306-147 (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
. Date fir_' _ "' 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:
/ ( )-1 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
SdLltien 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 g5'€': ,i' AUTdF� ' Policy No. M764lte-41042
(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.
/Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth. on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
,,,Signature (OwnedAgent)
,t rte.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT, s b Wg47 TRACT
JOB
`y{•��}}���qp��jjppyyyy
APN
ADDRESS ,y �,�1,[q4 �y$�p
- DIY"'.%"'4Ei' S.,•.l'161,6i..� I�IFi`..fJ:A4R4
''t if».1��"Y/'ILA' !.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ralmoGa
R01 BOX1 BOX141
LAQ11 ti}7s4 CA 92253
LAO D -TIAs. • CA X221-3 a;
(760)5158-1404 C -U-0 6M
USE OF PERMIT
151..4 S.P. SOD P.P.R141T 3": c; ES..WO P IVA1.1, PtaOt;.s'SPA.
ORDRN MAY
TRACT C r'trN;g2`it,UCTION
Pt2WUPATIO 1'?b.QO SF
t
4AIIPLGS.CIC,�M<7.RT 3a6.fIA O
�
t"•CaMTRt3CTION FEE $6211:0
R► 1@:C.l3ANICAI PER7fD1,-000-42'I-00 M.., ��.so .
F_L—EC,'TIZBCA'" FEW MUM,
P rural lmaFEY,%t9�:••!0 )L�-•41� 0�'0 �l:sft.(Jo
!TR.UY$C+Mc?'1`1OM M: • RESI'D 101 -000.2AIJ;,t,„Ip
GRADING FE )01-•000.42-3-060 S.ti�3
I?..I+1iIU,OP131 IMPACT IsE
13.1 1328 PLAN. 101-000-4<1,1m.1 5 �16e.Uo
- <<
n �i-s LESS PRil PAZ . ?S.
4250,010
JUN 2 7 2003
�1-11,,7
CITY
RECEIPT
DATEpp.
BY "'
DATE FINALED
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
Exhaust Fans
OX to Wrap
O
F.A.U.
Framing-
(F
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Farts & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final L
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 I
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
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) —
COMMENTS:
CERTIFICATE OF COMPLIANCEFs
Desert Sands Unified School District Z4C- coo
47950 Dune Palms Road 'Q °
- .. •. r - � ! BERMUDA DUNES NES r
Date 6/27/03 La Quinta, CA 92253 I r R INDIAN WELLS(n ANCHOE
No. 24635 (760) 771$515 ��t PALM LA QUINTA ,�V
INDIO
Owner Kellogg, .. APN # ` 773-234-022
Address • PO Box 1141 Jurisdiction La'Quinta i
City La Quinta ' Zip 92253 Permit # 0306-147
Tract # Study Area.
Type Single Family Residence'-' 'No. of Units 1 :. h
Lot # No. ' Street S.F. • Lot # No. - Street S.F'.
Unit 1 11 77940 Calle Sonora 1514 Unit 6 ,
Unit'2 , Unit,7' t ;
Unita ..,Unit 8
Unit 4 Unit 9
Unit 5 Unit 10
Comments Bothi Cert #24634 and 24635 used for CC#8370719 in the amount of $7,344.48.
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 m6bile'
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
r
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to i Y
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. 8370719
Name on the check' F Telephone `760/880.1725
' k Funding Residential
By Dr. -'Doris Wilson
Superintendent Y�
` Fee collected /ezem ted y haron McGily y• $3,239.96
^Payment Recd OverlUnder-
Signature
NOTICE: Pursuant toGovemmedcod 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 Districts) 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
DEC -27-2003 11:43 AM
CERTIFICATE OF l
(P
P
ELD VERIFICATION AND
TESTING
P. 02
Com.
=110er Narrif
Builaer Coni ct
Telephone
Plan Number
HERS ater T lepho a Sample -Group Number
hying Signature -�
Date Sample House Number
Firrn;C. HERS Provider; _TC.VL S
Street Aooress:��� City/St,
Copies to: Builder, HERS Provider
HERS RATER COMP IANCE STATEMENT
Tne house was. Tested Q Approved es 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
cor,>ply with the diagnostic tested compliance requirements as checked on this form..
40 Distribution system is fully"ducted (i.e., does not use buliding-cavities as plenums or platform returns In lieu
Of ducts)
Where cloth backed, rubber adhesive duct tape Is Installed, mastic and drawbands are used in combin
with cloth backed, rubber adhesive duct tape to seal leaks at duct connections. atlon
MINIMUM'REQUIREMENTS FOR DUCT LEAKAGE REDUCTION COMPLIANCE CREDIT
Duct Diagnostic Leakage Testing'Results (Maximum 6% Duct Leakage)
Duct Pressurization Test Results (CFM @ 25 Pa) Measured
.values
If fan flow is calculated as 400cfm/lontxLnumber
Flow
tICFM i
tons* enter
. calculated value here
If fan flow Is measured enter measured value here
Leakage Percentage (100 x Test Leakage/Fan Flow) _. y -
Check Box for Pass or Fall (Pass=6% or less)
Pass Fail
!L4THERMOSTATIC EXPANSION VALVE. TXV or Commission approved equivalent
Yes Q 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
C Yes 0 No ACCA Manuel D Design requirements have been met
(rater has verifled'that actual installation matches values In
CF -1 R and design on plan.
2 D 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,l and 2 is a. Pass
„
o
Pass Fail
Certificate.ofOccypanqy
ii, RATM �
C OF'I9� -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: 77-940 CALLE SONORA
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0306-147
'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
Jb
Date: January 13, 2004
Building Official
POST IN A CONSPICUOUS PLACE