06-1454 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
06-00001454
52580 AVENIDA OBREGON
T4ht 4 4 "-
BUILDING &. SAFETY DEPARTMENT
773-285-004-3 -000000-
DWELLING - SINGLE FAMILY DETACHED
COVE RESIDENTIAL
102047
Architect or Enginee
Lic. No..: OOR
BUILDING PERMIT
LICENSED CONTRACTOR'S 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 Class: B C36 C42 LicenseNo.: 205031
•
�ate:J —�— L�_"OContractor: '
4V/ OWNER -BUILDER DECLARATION
. I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec.'7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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 ($500),:
1 _ 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who -builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 that he or she did not build or
improve for the purpose of sale.). _
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: ��II
Lender's Address: IW
LQPE%MIT
Owner:
GRISWOLD HENRY C
30110 CROWN VALLEY PKY 203
LAGUNA NIGUEL, CA 92677
Contractor:
BELKNAP, DOUGLAS W
P.O. BOX 297
PALM DESERT, CA 92261
(760)902-7444
Lic. No.: 205031
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/27/06
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.
�0 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 and policy number are:
Carrier STATE FUND Policy Number 1576785
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 subje t tote workers' compensation provisions of Section
�y 3700 of the Labor Cod s all forth[ th co ply with tho a provisions.
1 g_� oG
Date: Applicant:
t�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($ 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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 th ove information i correct. I agree to comply with all
city and county ordinances and state laws relating to b ing onstruction, a hereby au
ori representatives
of this county to enter upon the above-mentioned prop ty for nspection pur e .
/— I�nature (Applicant or Agent):
e -
Application Number . . . . . 06-00001454
Permit
. . . BUILDING PERMIT
Additional
desc .
Permit Fee
. . . .
650.00
Plan Check Fee
422.50
Issue Date
. . . .
Valuation . . . .
102047
Expiration
Date
10/24/06
Qty
Unit Charge
Per
Extension
BASE
FEE
639.50
3.00
----------------------------------------------------------------------------
3.5000
THOU BLDG
100,001-500,000
10.50
Permit
. . . MECHANICAL
Additional
desc . .
Permit Fee
65.50
Plan Check Fee
16.38
Issue Date
. . . .
Valuation . . . .
0
Expiration
Date . .
10/24/06
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
1.00
9.0000
EA MECH
FURNACE <=100K
9.00
1.00
9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
4.00
6.5000
EA MECH
VENT FAN
26.00
1.00
----------------------------------------------------------------------------
6.5000
EA MECH.EXHAUST
HOOD
6.50
Permit
ELEC-NEW RESIDENTIAL
Additional
desc .
Permit Fee
. . . .
95.06
Plan Check Fee
23.77
Issue Date
Valuation
0
Expiration
Date
10/24/06
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
1604.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
56.14
446.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
8.92
1.00
----------------------------------------------------------------------------
15.0000
EA ELEC
TEMPORARY POWER POLE
15.00
Permit
. . .
PLUMBING
Additional
desc .
Permit Fee
. . . .
129.00
Plan Check Fee
32.25
Issue Date
Valuation . . . .
0
Expiration
Date
10/24/06
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
10.00
6.0000
EA PLB FIXTURE
60.00
LQPERAIIT
Application Number . . . . . 06-00001454
Permit . . . . . . PLUMBING
Qty
Unit Charge
Per
BASE FEE
Extension
1.00
15.0000
EA
PLB
BUILDING SEWER
15.00
1.00
7.5000
EA
PLB
WATER HEATER/VENT
7.50
1.00
3.0000
EA
PLB
WATER INST/ALT/REP
3.00
1.00
9.0000
EA
PLB
LAWN SPRINKLER SYSTEM
9.00
6.00
.7500
EA
PLB
GAS PIPE >=5
4.50
1.00
15.0000
EA
PLB
GAS METER
15.00
----------------------------------------------------------------------------
41.
10.20
DIF STREET MAINT FAC -RES
67.00
Permit . .
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date .
GRADING PERMIT
15.00
10/24/06
Plan Check Fee . . .00
Valuation . . . . 0
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
1604 SF. SFD PERMIT DOES NOT
INCLUDE
BLOCK WALL, POOL/SPA OR DRIVEWAY
APPROACH
----- ----------------------------------------------------------------------
Other Fees . . . . . . . .
. ART IN PUBLIC PLACES -RES
20.00
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
480.00
ENERGY REVIEW FEE
42.25
DIF FIRE PROTECTION -RES
140.00
DIF LIBRARIES - RES
355.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC - RES
892.00
STRONG MOTION (SMI) - RES
10.20
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1666.00
Fee summary Charged
Permit Fee Total 954.56
Plan Check Total 494.90
Other Fee Total 3768.45
Grand Total 5217.91
LQPM11T
Paid Credited Due
.00 .00 954.56
250.00 .00 244.90
.00 .00 3768.45
250.00 .00 4967.91
Certificate of Occupancy..
typy �ofw
Building & Safety Department
9 1
I 77T
I 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
q construction and/or use.
I
BUILDING ADDRESS- 52-580.AVENIDA OBREGON
I Use classification: SFD Building Permit No.- 06-1454
G s
r z Occupancy Group. R3 Type of Construction: VN Land Use Zone: RC
—
�I
Owner of Building. M/M DOUG BELKNAP Address: PO BOX 297
City, ST, ZIP: PALM DESERT CA 92253-
I By: K.KIRKLAND
a�
~! Date: 9-26-06
f : Building Off'cial
r'
I POST IN A'CONSPICUOUS PLACE
_ 0.3,C 4`1
Sladden Engin'e'ering
6782 Stanton Ave., Suite A 39-725 Garand Ln., Suite -G• 114-.& California Ave. 15438 Cholane.Road
Buena Park, CA:90621 _. Palm -Desert -C -A-92211.'' --Beaum n CA 92223--=Victorville, CA 92392
(714) 523-0952 (760) .772-3893 (951 845=7743 -� . 760 962-1868
ti
Fax 7.14)-s�'369 - Fax (760) 772-3895 _ F . (951) 845-8863 Fax 760-962-1878
Date,.', :k
FIELD 'MEMO Job No. 5 z.
Project Name J I _ r aI Client...
Site.Addressn
��jr2- Foams%' '-�, Clr
Job Phone
i
T.. Work Done t
--�— �e ' . u ,^� ` � �.`L Leer • e � 6 i t s
Test Summary / Footings Inspected
t
,�. Test "�------ � Dry .Moist %Relative Ref. Max Moist
No. kation ,7 a Elev. Density % Compaction pcf
U
Comments
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r
1 �
-Field Tech.
24'.hour notice: requested to schedule Field Technician: Thank you fort pp
Super.qcAgent
nity to. be.1of-service. -
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5
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`17- 1/1 15
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Comments
r
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1 �
-Field Tech.
24'.hour notice: requested to schedule Field Technician: Thank you fort pp
Super.qcAgent
nity to. be.1of-service. -