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0205-164 (SFD)(V W O =)C) d Z I� co O.o HCID Fa N Z M L0 N ON U0) dQ Nt Z ,aCr 0 XW mUU O d rnH NT Z o0 5 r, C) x , ., LICENSED CONTRACTOR DECLARATION I;Hereby affirm under penalty of perjury that I am licensed under provisions of Cdapter 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 11.1 03/31/2( D e 211 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). ( ) .l, 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 a'nd 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 OTAT S FUND Policy No. .til?M•.2gp2 (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 J.hgs5,,provisions. Date: � Applicant 41 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth ;on his application. 1. Each person upon whose behalf this application is made & each person at, whose request and for whose benefit work is performed under or pursuant to; any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such; C permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. �S,ignature (Owner/Agent) Date BUILDING PERMIT PERMIT# 02IMS -;$ill + DATE �. /%�w VALUATION �T LOT I TRACT BLK 257 JOB SITE ADDRESS APN f4 :( i�27 OWNER CONTRACTOR / DESIGNER / ENGINEER RM MTU X_ T1b /1 HOM BUR. CON .%si POiARY PC) BOa`/i $249 51371-AVEMAXX kHR;Fd UD 1 A:JC:)IL A CA 92039 I- .%%!INTA CA 92M (760)55Sw1404 C,."x3Lft 5255 USE OF PERMIT SDI) • 110I ; 15116. A'f':RMIIT I3093 140T INC' _DY RU:3CK; W,? LI„`, P0014 SPA, cap,.DRWWAYAPPRO_Ae H. TRACE'r:OMTRUCOY1014 409i,00 VF 61,0I3 u1 PLAN CHECK: I:;T+E 101-000,439-318 $60.14 RE DRT°OUP V50,00 A9Xr.°H ANfaw Al, YZZ 1.03rOU© 421-(1C1i1 $7'4.00 1t}:LrCTMAL M 103.000.47,0-000 $13.190 P1.UxsBINEt Pts : 101-000-419-000 $1:51.511 S't'Rt7NO Mt5ii'iON ME - RMID 101-000.241-000 $12.63 sRfi1)!1(f31VL 301 _0001-423.000 W. Do Mt:WHR IMPACT F&E $2,40,51016 PRfr.Cg3Z PLAN 101-000-441-345 $if)fl.OQ ST1111-TOTAL MW PT AX C.IBE K $4,203.01 LESS .PRFi -PALD Rei 425 V UU ` TOTAL 1"EMMIMIES DUE NOW $3,953,07 UC C1►Y of LA Qul A FINANCEOEH'T- DATE DAFINALED INSPE T R 11 . OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Q Underground Ducts Forms & Footings G/ Q 9EReturn Ducts Slab Grade Steel Air Combustion Air Roof Deck 3 • Exhaust Fans O.K. to Wrap _�� �� F.A.U. Framing Compressor Insulation ,p a' y� Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final Final �J=7�G�G 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 lam- r13 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 �Y% �— 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: 2v/ �G� el� Q - O 3 �! - Date 10/15/02 No. 23734 Owner Pacific Trades Construction Address 2551 State Street #111 City Carlsbad Zip 92008 Tract # Type Single Family Residence CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # Study Area No. of Units 4����FIEDsc�o BERMUDA DUNES V) RANCHO MIRAGE {� INDIAN WELLS �.� PALM DESERT y LA QUINTA �%IN0 y� O 774-214-027 La Quinta 1 Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 54200 Avenida Herrera 2081 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments 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 2,081 S.F. or $4,453.34 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. 7924875 Name on the check Telephone Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Monica Guillen Signature Ji("'Vv $4,453.34 $0.00 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 District('s) behalf, whichever is earlier. NOTICE: This P%4ment NOT VALID if Duplicated Embossed Original - Building;DepartmeritfAppiicant Copy - Applicant/Receipt Copy -Accounting ;Oca•l 0 1.•.: 02 :l 0: 00 . M: OM GP 'LC: F .TRA ' D - E -':INCS A N �309r�.05:'�'`.: ` c. -•r X200 'S _ �RBCORgI- RE QU �sr S� O X10 illt� C�° 1 z :PACII'1C TRADES CONSTIt11CTIQN' IWn.DEVEI.OPI4IENT, C�1IIT.0R %A CORPAR.dTlDN q N ql- __ . STRUCTURAL'DESIGN SOLUTIONS INC: e5qJanuary, 15,.2003 Greg V. Malsen West Coast Builders 77848 Wolf Road Palm Desert, Ca 92211 Phone: (760) 200-4583, Fax (760) 200-4563 Re: McComsey Residence La Quinta, California SDS Project # 302001 Dear Mr. Malsen, This letter advises that we have observed the structural requirements that are visible during construction of the above -referenced Custom Residence. Structural Design'Solutions, Inc. believes that the as -built construction at the time of our visits is in general conformance with our structural plans and relevant correspondence issued by our office relating to the above -referenced dwelling (structure). We observed the building in its framed condition prior to installation of drywall and stucco. We observed the visual and accessible structural requirements. (Exclusions are items such as: size of footings; reinforced steel in the foundations; roof and top plate splice connections; and roof sheathing). This report is understood to be an expression of professional opinion by this engineer, and is based on his best knowledge, information and beliefs. As such, it consists of a report only for structural elements (as outlined above) and is neither a guarantee nor a warranty, expressed or implied, for other trades or requirements of subject dwelling (structure). Respectfully Submitted, StruYAbdelfatt esign Solutions, Inc Bash/Principal QUO?PQFE55/O�/ ABD No. CO5 24 70 UP. 0'/ A CIV11. \Q' qTF OF CAO\70P9 1820 E. Garry Ave., Suite 108, Santa Ana, California. 92705 Tel. (949) 435-1065, Fax (949) 435-1064 support@sdsstructural.com Jan.21. 2003, 8:26AM:3 FRCONTEMPORARY TO 9-5686072N 0. 0 2 31 P. P. 111 � � Infonnaiion��e o —. oTo Build On fihg/1/eeffng • OonwMM • Teslgng REPORT OF FIELD COMPACTION TESTS TESTED FOR: CONTEMPORARY HOMES PROJECT' 54-200 &VENIDA HERRERA LSO BOX 1141 LA QUINTA, CA LA QUINTA„ CA 92253 DATE: January 23, 2003 OUR REPORT NO.: 073-30034-2 TEST DATA: (1) Medium grained silty sand_ OPT. MOIST. = 11.0k COMMENTS - PERCENT Spec. 903 Min 95.9 1 - A 93.7 1 - A 93.4 1 A 94.6 1 - A _MST NO. TEST DEPTH ELEVATION Fp SOIL ID NUMBER LAO DRY + DENSrTY -ATCR CONTENT vrET OENSI?r ORY DENSITY 1 8" 1 1 117.5 9.7 123.6 112.7 2 3 6n 8" PG 117.5 10.3 121.4 110.1 FG 1 117.3 11.1 122,0 109,9 4 8" FG 1 117.5 10.8 123.1 111.1 TEST LOCATION: House pad. I NW corner 2 NE Corner 3 SE corner 4 SW corner NOTES: TESTI PERFORMED PER ASTM D2922 -e5 & ASTM D9017-96 •COMMENTM �: gI N�TBRIAI A T Sj RESULTS CC F IrowIF01WLgn8 pEN Lbs . psr LUDIC I KILL 0. P N ►_ pMPAI % CO L VJAT R pN7ENT: �er�eht of eJty weiphl_ 3. BASE COURSE WITH POE I`ICAT p PFJi Et� COMPACTION; BeseO on maximum dry d, BBASE C. RETE jj PR OUS ST �pl� @di'ID nvDln�oe on samlrle Indicated by e'INBAAENT MOISTURE $6 OC PE FC5CA ON3ATIONS + (1) ASTM D1557-00 METHOD A TEST INSTRUMENT., STANDARD COUNT M: D. REMARKS: PSI did not monitor the material Placement- ADJUSTMENT DATA M: D: I Respectfully submitted, TECHNICIAN: Juan Nunez Professional Service Industries, Inc. THESE TEST RESULTS APPLY ONLY TO TMC SPECIFIC LOCATIONS NOTED AND MAY NOT REPRESENT ANY OTHER LOCATIONS OR EIANATWIW. AVORTS MAY NOT BE R6W000CED. EXCEPT IN FLILL, wTTNOVY WRITTEN PERMISSION BY PROFESSIONAL SERVICE INWITIOBB, MIO. PSI A-100.2 W. Professlonal Servloe Industries. Inc. • 42.240 Green Way, Suite C • Palm Desert, CA 92211 • Phone 760/341-1790 _ Fax 760/341-5794 ** TOTAL PAGE.01 ** `v��- - ���- .. Al • : .. x < Y ` • � �` ! Yl 0000, - Certificate of Occupancy0 o Q Lm�oxn�n�� c OF'IBuilding & 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. t r BUILDING ADDRESS: 54-200 AVENIDA HERRERA Use classification: SFD Building Permit No.: 0205-164 Occupancy Group: R-3 -U-1 Type of Construction: VN Land Use Zone: RC E Owner of Building: ROBERT B KELLOGGITHOM BUFFIN Address: PO BOX 8249 City, ST, ZIP: LA JOLLA CA 92038 By: KIRK KIRKLAND Date: 08-27-2003 fi Building Official a I s ; POST IN A CONSPICUOUS PLACE