9909-264 (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
34)196
Date �� / 9C Signature of Contractor
OWNER -BUILDER DEC AL RATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: - 1
( ) 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.
(K 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 Policy No.
fiisi'fMLIC INTD Or, AA 006"$934rl
(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 Sectie, 3700 of the Labor
Code, I shall forthwith comply with those pro .ISO
Date: t� Applicant --l!" l! • /•✓
r�
Warning: F Ilure to secure Workyls 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)Z� //r.,�/Date l?�_ 7
11;1u
PERMIT #
BUILDING PER
64
DATE .12/13+,1.9f9VALUATION 5343,11.f.30 LOT 57 TRACT ' :R470.2
JOB SITE 4,?
DRESS ? �' y T1;,LKLNG. ,icf)CK TUMN
APN f
749-162_0()2
OWNER
CONTRACTOR/DESIGNER/ENGINEER
_
1!'. 1� S F. x:' 11 LY
LY PACIFIC `r1*1,r fZ'UC''4(-
am t.. �.. �.� �... ...+.�i.to..a IA,
100 O'kAK:ES LANiINGROAD STT 1 05
10 DRAKES .LA.N1 DNNk'J iaGiW S E 105
%i.i; :tail #tt1L kA 94904
uk1_L•:NB"kAl' CA. 94904
(41-1)464-0900
USE OF PERMIT
DWELLING
5F0 - NO BLG X WALT � �: R POOL. CiJti�il''LtraNCE, W!.! H i\LL FM- ERAL �w
S•1'A'I'.E LAW3,1NC;l.OVING TkW, HN1JAN4Lgd;D SPECIES XC.( CAF W73 J 16
U.S.Q. q .1531, Of SEQ.) IP APPLICABLE. IS i.tiE:.QUII I:D.
= us—i C01iiIiEt r --n. o 1 1,790.00 SIV
PvtZi 1rlii�Fii 3G 747.00 &F
f3a1K1u.3L••'�:AfiYt�.it� . SI;.'.+h) Sl~'
.
MART FIX SUMMARY -
C NNSrKUCrK)N1-i;r•, 1.01-000-411-000 $1,rfXyo
Pr,A'N("4114 VFP 10144)-4:3U-31fi
t' :Ir "i`S �' 1Q1-0011-139-'1�-$1'000.00
�I
I�Ihk, AlvIOAI, tTs 3124.0-.
4LECTRIC AL FEE' 101.000-4211-OQU
t�f,irgrlRrnrll �►:� 1tl1-#)00-419-(1ttt1 �1�I �n
`�" : � 1� ,
;`PRONG fOOTION FIS - XESU) .101-000-241.000
01tADIN0 17 -hiss 10i-050-42.3-000 $:tt►.t i
O VP,LOPF,N IIMP.A(71' Flit(
4MfT INPLiSITY PL.A_(TS - WFSJ'f, 70!4`1410-2554)()fi
!-Y1Nj;'` Rf IC'i'ft��I
LESS Pr; •I'AM 1n EIS,
41,1000,00
TOTAL PEJA11114 FEES 10F, NOW
��^xEltl.4.f
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
l
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE _T
'INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel—^-�
Roof Deckl�J
O /
Combustion Air
Exhaust Fans
O.K. to Wrap
_�
3 _�
F.A.U.
Framing
civ s
Compressor
Insulation
_ 3 -•e1� 3
Vents
Fireplace P.L. Gd
, —� 15
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
—A4- CJCg S
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection1
Encapsulation
Gas Piping
- Z� w 571,
Gas Test
— .a :
Appliances
Final
COMMENTS:
01�410 2 -If -w 57
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
qp
Building
Address
James F. Kelly
Mailing
Address 100 D
City.' -
's Land
zip 9AJ04
4 4Q"
P.O. BOX 1504
,2 -T 78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
r
BUILDING: TYPE -CONST.
n Road, .$te105 A.P. Number
Tel.
15--464-0900 Legal Description Lfn
Kelly Pacific Construction,Co.
Address
100 Drakes Landing -Rd., Ste., 1Q5.-
City Zip Tel.
Greenbrae CA94904 415-464-0900
• State Lic. City
& Classif. 346196-B-1 Lic• u
Arch., Engr
Designer hunt Hale Sones -Architects ,
Address Tel.
636 Fourth.Street 415-512-1300
City Zip State
San Francisdo -94107 Lic- n-�gD�jQ
I hereby affirm that ham licensed
7000) of Divisi�on'/3 of the of
etfect. 4 /� 4 %fir
' 9 (commencing with Section
my license is in full force and
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:' /Sec. 7031. S, 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 (8500).
I] 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 thal he did not build or improve for the purpose of sale.)
I'1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
-strucI 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 Jd the Contractor's Licens9 Law.) r
i ] 1 am exempt under Sec. F�/8 P.C. for this e� n /�/ "
rDate _1 �24L �twner
WORKERS' COMPENSATION DECLARATION
1 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
r] Copy is filed with the city. 0 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 thg 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., It, 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
ame
Lender's Address ' z
This is a building permit when properly filled out, signed and validated, a d is subject to
,expiration it work thereunder is suspended for 180 days./ �%
I certify that I have read this application and state t the above i ��rt)ation is correct.
I agree to comply with all city:�nd county ordinances andate I s relating to building
-construction, and hereb authorize representativ s of t ts�cil ,le ter the above-
mentioned property for i specti ro ur oses.
,7,,_ l % x•20- q
Signature of appli% ant Date
Mailing Address/ t� _I V Ak�S ZNtl+art ctt.l�ltr�'C.. �0
City, State, Zid Y eAv�hrarz CON 4 1904
r
WHITE = FINANCE
qcio15 -2c
APPLICATION ONLY
OCC. GRP.
Project Description
- - All • 4G4- 0q00
Sq. Ft.
Size
New ❑
No. No. Dw. '
0 Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
FM/Yi` . _ 1M LV rJ '-II AI IV1141, -11NIL
4t5 - 5t2--t3fJV
Crk�t_ we1aJ 5eueor_ I_17Tr.Q 2+bA0� : I�t4¢lL Powi:f-1- 433(0'02{
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. ,; ' • f
Const. ! i/
Mech. f
Electrical °
Plumbing
S.M.I.
Grading '
Driveway Enc.
Infrastructure
TOTAL
REMARKS.
ZONE: BY:
Minimum Setback Distances:
Front Setbackjrom Center Line
Rear Setback from Rear Prop. Lines
Side Street Setback fro-penterMLine� t f e
Side Setback from Propehy`LineY
FINAL DATE INSPECTOR? AN
Issued by: Date Permit
Permit
Validated by: �� 1 i � LA
Validation:
YELLOW = APPLICANT
{r
PINK = BUILDING DIVISION
f
Notice:
Document Cannot Be Duplicated
Date 12/13/99
No. 19744
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameJim Kelley - Kelly Pacific Construction
No. 78-411 Street Talking Rock Turn
City La Quinta zip 92253
APN # 769-162-002
Jurisdiction La Quinta
Permit #
Tract #
I , Lot #
Type of Development Single Family Residence
Comments
Log #
Study Area
Square Footage 4790
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 mob; eliomes_ It.
has been determined the above-named owner is exempt from paying school fees at this time due to the following -reason:
MV -
i
S ;
This certifies that school facility fees imposed pursuant to f Government Code 53080 in the amount of
1.93 X 4,790 or $ 9,244.70 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/BAnk of Marin/Mark Powell Telephone 760 409-4848
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by
__ -Signature
Olivia Aguirre Payment Received $9,244.70
Check No: 013818-
NOTICE:
13818
NOTICE: Pursuant of 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
above 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
collect them on the District('s)(s) behalf, whichever is earlier.
Collector: Attach a copy of county or city,plan;checle application=form to district copy for all waivers.
Embossed Original- Building Dept./Applicant • Copy - Applicant/lIeceipt Copy - Accounting
12i0S!99 11:14 FAT 760.568 5974 IST AMERICAN TTL
y�
a�
Qrdcr 2093457—EL
. mowNNo.eR9Mng Hequestea HyRj;cElVEo�67 ,.
`"�'� %t American Title in5a(
raoce COMWv 9WTW °�T�` AT 8:ooAM CbFib
�r ItEi oRDen I�AI� rp: - ryr.�• 0.e00t JUN 2 31 79$6
Jemea F. K831y,
636 0,01lego Avenue
Kauttield, CA 9490n
MAIL 1'AX STATEMMaS iU:
Sptcc>tbava Ibis fma for Iter Fea6 _
DOCUMENTARY TRANSFER TAS( i9z 1 a
_-M—Camputed ao tha a-4deragou ar eelno of property
conveyed- M
S,11vtEi AS ABOVEx � Contputtd aq the GottsidePhort or viluc teas liens or
cnrum4ranM reauihdng ut time oriole r
Biwukt-m oflleeipent or Agent descra"gs tawFhm Name
Ar• N;
TRA.. G' p . C"iRANT DEEh
FOR VAt UAHLL CONSIDE CATION. r�celpt of WWch is hereby U60 ledged. r
K9 �J .
TRADITION CLUB ASSMATFS LLC a Dd..rjMM Ga6te4 lijbilily wow
herebyGRANTS)to JAM sl; P. Keely, Ali Unmarried Kan
Cx
tl>z P+oltY In the Ctty yr La Quitus
Ciwily aFRivcYsidts State O(Qkruniik descsihsd a} I .
Lot ._jL Tract 29470-2 (Ste edoblt "A" Atte W Rude) '
r - �
Datedr Man;h 2. 1998 i
i
5lateofCafifcrn;a ) • � ,�
County nF 'T-1 1—)
On
be r«a
rRAo o ua LLC..�
pCraonaAy �Pm� Q�nVy[. a Drta icedly
personally ktwwn to me (or proved to the on G oPsuisfagory
Cvidence) W be the petwcrj whnsa t�mhtmled to the g .
widw+ k uwent aW acknowttegod to me t ectII
ame' crnhcir mhoijud c�p¢ci1y , , 4Md thu b kheir �kk1
aigtptur�A`on the 1rwtumaat the pc_nJp)'Of the emItY upon behalf of
which the pcmn anted, exeaued tie Inn umv-sit: �-tTtY'LVJCE PAFS1bEk
WITNZ55 MY HA t30MCIAL SEAL
y AiGRRIIf� f $FjAjj2jd�l4
n
q tvc�o�yMy tCi34
utab
• • Mfu�i�1T, tye'•.� �F
' C
• (Tres Brea for ofI1Cl31 natarlu �I I r�r
' F
M
Tradifion
ARCHITECTURAL DESIGN REVIEW
December 1, 1999
Mr. Greg Butler
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Via First Class Mail
and facsimile
r
Re: Kelly Residence, Lot 57, Tract 28470-2, 78-411 Talking Rock Turn
Thar Ctraa
Please accept this letter as approval for the above referenced residence to obtain a building
permit. Conditions that apply to this submittal will be forwarded directly to the architect,
Mr. Jarvis Moore of Hunt, Hale, Jones Architects.
If .you have any questions or need additional information, please do not.hesitate to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
pc: Gary Domer, Kelly Pacific (via fax, 415.464.0463)
CNdy D-&VADRC [d1 00&npd
78505 OLD AvENuE 52 -- LA QuiNrA -- CA 92253-1120 — PHONE 760/564-3355 -- FAx 760/564-2356
� z
U S
,r. � mak•
cF`yOF tN�O
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Dear Builder:
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared by a licensed surveyor, or engineer, are on file in the Public Works
Department.
2. Verification that infrastructure improvements and other required tract improvements
are complete, or sufficiently advanced to warrant building permit issuance.
3. Prepare an engineered grading plan that provides for on -lot storm water retention,
and have it checked and approved by the Public Works Department.
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates).
4. Prepare an engineered grading plan that provides for building pad grading in
accordance with the existing soils report and tract grading plan, and have it
checked and approved by the Public Works Department.
• Tract 28034 (South .Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT-
LOT: S
�, �4�4
PU LIC WOR AU O TION ATE
F:IPWDEPTTDOCS%FORMS\PW CLEARANCE LETTER.ss
COMMENTS:
Certifidate ofOccu pancy
Citvof La061nta.
.
Building and YDepartment.Safet
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
ollowing:BUILDING ADDRESS: 78-411 TALKING ROCK TURN.
-Use Classification:' SFD Bldg. Permit No.,- 9909-264
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JAMES F. KELLY Address: 100 DRAKES LANDING ROAD STE 105
City: GREENBRAE, CA 94904
By: STEVE TRAXEL
b'h�t Date: 10-12-00
Building Official
POST IN A CONSPICUOUS PLACE