SFD (0106-216)51920 Avenida Madero
0106-216
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
B C,36 042 l'` 11 nwv
Date _ Signature of Contractors
Y
OWNER -BUILDER DECLARAT OI
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:
Cartier Policy No.
(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 -.S ctio/n`3700 of the Labor
,od~e, I shall forthwith comply with those provisio Ps. o
Date: ^ -% Applicant t 't,
c
Warning: Failure to secure Workers' Compensation co. rage 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. 04 -
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) Date 4/9, .
BUILDING PERMIT PERMIT/t
DATE VALUATION LOT ( S (?P.;l TRACT
t A"ALIM T fl1.4 I M.
JOB SITE
ADDRESS
APN
51-920 d1W.1 AEt,T"MRR0
77345A -M
OWNER
CONTRACTOR/DESIGNER/EN INEER
X.Al FES C.
JAMM G. BMW", JR
70-300FRUD. 1XN9M LINE
73-300 FIT)M= LANE
PAIMI'JIY:1~'STM C.A. 92261
J IAL di M ". '4'EIRT C'A 92261
cI-60}R 37.1566 0814 2901.5
USE OF PERMIT
N-1YI:,MIT 1. ES 7JOT INCLUDE FC? L, %1L0C.K W. AT.LS 0.. R 1ZRPVoVA Q'
AP NOU-M.03i (MASTER BC, I S54)
'CMCT (:010TRUCY'ION 1131M. 00 OF
POR11.141P A.'f.`20 I 85.60 s17
UARWYMARPG9€1.'1.' 440,411 SY
5 FT, WOOD F7140E. 200.00 ,LT
oir 4.L.. 'd,VA `.Xdtl, ii'b. o
9.5%i, d `i3V
spy y ,y p ;p((y y 'Aye/y ; t by,eY i, . :7VA.i`7.d. 7 .)'+r s'rJr
A.".Y.rfyyk ;..iY,,ryry:. T
, ,+{,ivy t{ f ,ryg
pYy6r+y6.'.r.`6 tVq i7 'b.SR.M-'fY 101-000-418-000
rs ONI iT. VP .71.ION n ..`9 101 mVV0-418- 00 101. 9p
PLA'T3 CH1 X 1' ,F 101-C-00-439-319 $524.38
FFIF: DF1410.8E1, 101,-11411.439.318 _321 OO
MECHAMC L M, 101-000-421-000 $77.00
T?:11FU.IM"AI,13p 101.000 -420 -OW $111,21
1:'lIUMBINO ITIM.. 101.000-419.000 $136.00
0TR09kI MOTION FP-1?EE&D 101-000-241-0300 39.601
ORA 'DTkQ, aVE , 1411-000-423`000 X20.fyt+
TAY1"A,OYyEit•1M1?AM IRE - 0STe9"i. o
PRECISE F+LKN 101 -WO -441-345 $1Qt1.ETI3
n ill lEfOTAL TRUC 1011 MO PLAN CvYZX K
$1,503.49
DInl :1X&I ;!'MMMD IV, FUSS
42,50.00
AM
JUN 2 8 2001
S3,251149
CITY OF LA QUINTA f
FINANCE DEPT
DAT` % ` / V
BY'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings A-1 -y
t—
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck oc r
Exhaust Fans
O.K. to Wrap -a(. p( 57
F.A.U.
Framing o
1 'L
Compressor
_
Insulation C
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath _
4
-
Drywall - Int. Lath
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 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 _i— . p IL
Appliances
Final
COMMENTS:
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) -
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/27/01
No. 22184
Owner NameJames C. Belknap, Jr.
No, 51-920 Street Avenida Madero
city La Quinta
Tract # B31U2 Lot # 16
APN # 773-154-009
Jurisdiction La Ouinta
Permit # 0106-216
Log #
Zip 92253 Study Area
Square Footage 1554
Type of Development Single Family Residence No. of Units 1
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 or replacement mobilehomes. It
has been determined 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 Government Code 53080 in the amount of
2.05 X 1,554 or $ 3,185.70 the property listed.above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may nqw be issued
Fees Paid By CASH - James Belknap, Jr. Teieuhone 760-837-1566
-- ri
Name on the check =+
a
By Dr. Doris Wilson= -
Superintendent
Fee collected /exe ted by Annette Barlow
Signature
Payment Received $3,185.70
Check No.
IOTICE: 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
bove 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
ollect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
014(0 -'7_I(7
51- Rio A V67
Building
Address
Mail
State Lic.
& Classif.
Arch., Engr.,
Designer
Zip
Zip
-+JiSr{.✓i.--+ri-.r4J 4-• -lulu.-wJ -i,`.--„r. ..+ r.r..:4+1':-:> _...-•+,• • M. .,... ,,,, .__ „, _ .y .-. .`
20 P.O. BOX 1504 APPLICATION ONLY
0 78-495 CALLE TAMPICO
- 'LA QUINTA, CALIFORNIA 92253
State
Zip9 f/_ 7 ILic.I
BUILDING: TYPE'CONST./ OCC. GRP.
A.P. Number 1 !/F l l
Legal Description
Project Description i c - r r I!'• '
- LICENSED CONTRACTOR'S DECLARATION`
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, after, 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 that he did not build or improve for the purpose of sale.)
1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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 to the Contractor's License Law.)
17 1 am exempt under Sec. B. 8 P.C. for this reason
Dale Owner - -
WORKERS' COMPENSATION DECLARATION
I 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. (S 800, Laborde.)
Policy No.f 1(/' /,' 'n Company --y t"/'' ' c 60
n Copy is filed with the city. ❑ 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., If, 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 Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes.
Signature of a0pl
Mailing Address -
City, State, Zip_
tstfmated valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
2 .
ZONE: BY: --- ------_ I
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
}
`
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑
Add ❑ Alter ❑
Repair ❑ Demolition ❑
IV
- LICENSED CONTRACTOR'S DECLARATION`
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, after, 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 that he did not build or improve for the purpose of sale.)
1'1 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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 to the Contractor's License Law.)
17 1 am exempt under Sec. B. 8 P.C. for this reason
Dale Owner - -
WORKERS' COMPENSATION DECLARATION
I 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. (S 800, Laborde.)
Policy No.f 1(/' /,' 'n Company --y t"/'' ' c 60
n Copy is filed with the city. ❑ 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., If, 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 Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes.
Signature of a0pl
Mailing Address -
City, State, Zip_
tstfmated valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
2 .
ZONE: BY: --- ------_ I
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
IRECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
James C. Belknap, Trustee
32 Camino Arroyo Place
Palm Desert, CA 92260
A.P.N.: 773-154-0094 TRA N: 020-017
5 t • 920 A46 MADEeO
Space Above This Line for Recorder's Use Only
'Order No.: 33013201 Escrow No.: 2-33674
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $27.50
[ X ] computed on full value of property conveyed, or
[[ ]] computed on full value less value of liens or encumbrances remaining at time of sale,
unincorporated area; [ ] City of La Ouinta , and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Marvin J. Buur man
hereby GRANT(S) .to James C. -Belknap, Trustee of THE JAMES C. BELKNAP, . JR. SEPARATE TRUST;' dated
May 5, 1992
the following described property in the City of La Quinta, County of Riverside State of California;
Lot 16 in Block 31 of Santa Carmelita at Vale La Quinta, Unit No. 2, as per map recorded iri Book 18, Page 55 of
Maps, in the Office of the County Recorder of said County.
Marvin J. Buurman
Document Date: May 22, 2001
STATE OFC ORNIA )SS
COUNTY OF y ': ,iQ. Lj ) -
On before me,'m
personally appe re— d "CLV y , t;,
(or proved to me on the basis of satisfactory evidence) to be the person(o whose name(sf is/aP6 subscribed to the within instrument
and acknowledged to me that he/she/tht'y executed the same itl pt/dpir authorized capacity(ies) and that by his/hpfr/their. signature(sy on the instrument
the person(O"or the entity upon behalf of which the personal acted, executed the instrument.
WITNESS my hand and official seal.
Signan %f –(/ l G
OFFICIAL SEALcc]
tLIFORNIA g
COMM. NO. 1177516
SAN
MDUNTY
Y COMM-IEXP, MBAR 21 2002
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below
RC DISTRICT -PLANNING REVIEW FORM
This form is to be used by CDD staff for review of single family dwellings in the RC (Cove Residential)
District, in order to determine the applicability of compatibility issues or need to require the filing of Master
Design Guidelines by the applicant. It shall be transmitted to the Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT BELKNAP
SITE ADDRESS
-7-7S - t54 - 00cl
APN qq3 16-1 ^ ^ `' 6- *BIN NO.:
LEGAL: LOT — fo BLOCK
CHECKED BY: Fred Baker
1-920 Ave MAMvZo
CASE NO.: 2001-458
-3-3-- 31 UNIT 1' S.C.@V.L.Q.
DATE:
Inform the assigned Building plan checker upon your assignment to this case. The CDD Executive
Secretary maintains a log book to track applications and assign case numbers.
REQUIRED ITEM
Y
N
COMMENT/CORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as.applicable
MDG filing required (5 filings since 9/3/98)
Consistency with street/surrounding area:
Colors
Materials
Architecture
Other Requirements:
Cmf A -pis ILI"
Certificate of Occupancy
City of La Quinta
Building, and Safety Department
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 ADDRESS:
Use Classification:
Occupancy Group;
SFD
51-920 AVENIDA MADERO
R 3 Type of Construction: VN
Owner of Building: JAMES C. BELKNAP, JR.
Building Official
Bldg. Permit No.: 0106-216
Land Use Zone: RC
Address: 73-300 FIDDLENECK LANE
City: PALM DESERT, CA 92261
By: STEVE TRAXEL
Date: 10-12-01
POST IN A CONSPICUOUS PLACE