SFD (0202-212)51925 Avenida Martinez
0202-212
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
2W031 B C36 C42 HI 1113 W.
Date _1f, ;r, Signature of Contractor f ✓
a 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 '
() 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:.
CarrierSala P. FU)Ji) Policy No. 1 ?i5"iu 9
(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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person ,upon whose behalf this application is made & eachperson at
whose request and for whose.benefit work is performed under or pursuant to
any permit issued'as a result of this applicaton agrees to, & shall, indemnifYIe
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date •Tr t c.7
BUILDING PERMIT PERM*T#
DATE VALUATION, LOT `g' TRACT
JOB SITE y
ADDRESS
APN
773-11 14115.021
OWNER f
CONTRACTOR / DESIGNER / EN (NEER
SAWS C, -90"API JR.
Dox 2,97 ,
IAY1E
7 xp. 3' 0ga
/ .y
rr:)AT.I i Xli:A7RR i CA, 92.261
( n xN t;:K
7 y y
A 'd"Y.Y+lY6.:./.i Y7L . .A..f CA 92261
2905
!
USE OF PERMIT i
1,
ilk) - .PEF?ILU ]iGiM'NO T INC:7.i OY, SLOC:SC'd Ai.G, POOL, OR LDC!' S' 1 "
M)PR.OACH 98 MMOTER PLAN TR,AP1640° (H,01. -NAP)
'7.P ACT {yOVS3'RdiMOA 1,( .tta )!
"E'OI:r.C:,1'9✓R t IO 2 I fry. j
[a }
. 1T'S1 (.0F'eC 1VXP`YRqt 420.0/j0 kiL`
J y=Nr. ,nXD MC.E 130,00 Lit"
R'Rkl '. XIM COU W w'CAN15I'k UC•"1.`, ON
t3ir li
CONSTRUCTION FRE 101.0 00.4188,0 0
PLAN CHECK11P, 01w000••439-:.31.$ $525.31
MF DE'POMT , 101-0 00--439-318 -318 •`hM.0)
AA,ECHAVI )CAL FEE, 1}11.00-0-421.00.0 a.13
ELF, 'TRIC AL, M 01 -OW -420-000 $10101
;?)..UIVIBIN Db' E 102-000-419-000 $11f.15
:' TRONO bROTION K,1'f , .1 !?MD 101.000.2416000 s3;1)
E1iRd°1WN DFES' 1111-000.423-000 M10,0
131+1i11!.LTJPU irhPAC'1' +'F,E S'i,9knC1
[ I21re. 1.s T`I, 'E+1 ifA1*(120- t #•1.. ti• $ltrlO.t7J
UB- -TWAL CCNR11'L'i0"T1W Aim P1. AI x Cl? ".1 .,M
1D3,.d t i• C
.xs ' .n + . tw' :r IS' •!5 . ' h .. s . F R N•f• iaJW iT1iJ.:
alJ6 . i
l -,=, 50.00
41 -
MAR 11 ?0IIJL
CIiYOFLAQUINT- 0,
P-
RECEIPT
DATE / '*
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
a 10Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
(o , d
F.A.U.
Framing
• ( •d7__�
Compressor
Insulation
- .91--
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 5- -02 c- fitG4L..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
O2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
� _ _ _
Pool Cover
Encapsulation
Gas Piping
Gas Test 15
Appliances
, p y
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
COMMENTS:
. # "T{' -4.i ' n; .Fs% L ri, ,`!'1' ' r.:•n' S" il , bit•.''•';,tti .t -
• vl.o
P.O. BOX 1504
oul lul11g CS)l I f f v ` E A4 _ 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
APPLICATION ONLY
Owner
>
BUILDING: TYPE'CONST. f r OCC. GRP.
n
Mailin g
Addres l
A.P. Number
Legal Description
Project Description
C e t }
IZ%,,,,IlJTe12._
Contractor /
Addre117
r
t
Zi
Tel
'
0+
State Lic.
City ,
K Classif.
Lic. #,via D
v
Sq. Ft. 1 No. 1 No. Dw.
Size ! f Stories Units
Arch., Engr.,
ce,—L
Demolition ❑
Designer
S
New ❑ Add ❑ Alter ❑ Repair ❑
, -
JIGIG
Lic. #a
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 Contractor's License Law for the following
reason: (Sec. 7031.5,9usiness 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) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for thealleged 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 (5500).
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, 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
111, 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.)
1-1 1 am exempt under Sec. B. & P.C. for this reason
Date 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. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WO R K ERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
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.
Date Owner
NOTICE TO APPLICANT., d, atter making this Certificate or 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
Ihereby 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.
I 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 applicant Date
Mailing Address
City, State, Zip
PJ . , l "ADI'D l.\
EstimaT> ation .,
PERMIT AMOUNT
Plan Chk. Dep. ,r
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
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:
1
CIT" OF
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION FIMIAM
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 3/11/02
No. 23030
Owner NameJames Belknap
No, 51-925 Street Avenida Martinez
city La Quinta
APN# 773-175-021
Jurisdiction La Quinta
zip 92253
Permit # 0202-212
Log #
Study Area
Tract # BLK 117 Lot # 9 Square Footage 1,604
Type of Development Single Family Residence No. of Units 1
Comments
Family Dwelling of 1604 sq. ft.
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
2.14 X 1,604 or $ 3,432.56 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/ Guaranty Bank - James Belknap
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott
Signature (0" 5 a__
Payment Received
Telephone 760 837-1566
f.
$3.432.56
Check No. 2058332
40TICE: Pursuant to 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 check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
ale w rN S-- .. 9 2 s5
RECORDING REQUESTED BY
AND WHEN RECORDED MAIL TO:
James C. Belknap, Jr.
Jacquelyn L. Belknap
Douglas Belknap
Cecilia Belknap
32 Camino Arroyo Place
Palm Desert, CA 92260
A.P.N.: 773-175-021-9 TRA #: 020-016 Order No.: 33032244
Above This Line for Recorder's Use Only
GRANT DEED
Escrow No.: 2-35011
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $27.50
I X l 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; [ X ] City of La Quinta , and
FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged,
Frances Loussararin, Successor Trustee of THE GONZALEZ IRREVOCABLE TRUST and Frances Loussararian, a
married woman. . .
hereby GRANT(S) to James C. Belknap, Jr. and Jacquelyn L. Belknap, Husband and Wife as joint tenants as to an
undivided one-half interest and Douglas Belknap and Cecilia Belknap, Husband and Wife as Joint Tenants as to an
undivided one half interest.
the following described property in the City of La Quinta, County of Riverside State of California;
Lot 9, Block 117 of Santa Carmelita at Vale La Quinta, Unit #12 as per map recorded in Book 18, Pages 79 and 80 of
Maps, in the Office of the County Recorder of said County.
Frances Loussararin, Successor Trustee
of THE
Gf ONZALEZ IRREVOCABLE TRUST
By: ✓ lGi2C4?
Frances Loussararin
Successor Trustee
Document Date: November .29.- 2001
Frances Lossarari
STATE OF CALIFORNIA )SS
COUNTY OA_ Orange )
On. December 12, 2001 before me, Katheleen Florence
personally appeared FRANCES LOUSSARARIN
personally known to me (or proved to me on the basis of satisfactory evidence) to be the persons) whose name(s) is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument
the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my ha yd and official seal.
Signature-
L%
ignature LQ r
z
9Jh
Katheleen Florence KATHELEEN FLORFIVCE
Camissfmt ik 1
Notoy►r1'llbtjC _CdmmrAo
"Mm awI
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below
CITY llt LA QUINTA
c : o BUILDkG &,SAFETY DEPARTMENT
"OeT , ;.r., 777-7012
Y; -',INS,R,ECTION'REQUEST LINE
..I - 777-7153
JAMES BELKNAP
Owner
JAMES C. BELKNAP, JR.
Contractor
0202-212
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
51-925 AVENIDA MARTINEZ
JOB ADDRESS
SFD - PERMIT DOES NOT INCLUDE
BLOCKWALL, POOL OR DRIVEWAY
APPROACH. 98 MASTER PLAN "BNAP1604"
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING _ PRE- ;UNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB / i U l
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBIN
ROUGH GAS & AS TES D
HEATING & VE
FIREPLACE '1
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION".,<' 4_Z.. L
PRE -ROOF
\ COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK -
G'
FINALS
ELECTRICAL 7
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
r TEMP POWER _
.... - _......- I Inc o1f21.1T T(1
'Certificate of Occupancy
o
City of La Quinta
ow
Building' and Safety Department OFTM `
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:
51-925 AVENIDA MARTINEZ
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: JAMES BELKNAP
Building Official
MAI
Bldg. Permit No.: 0202-212
Land Use Zone: RC
Address: P.O. BOX 297
City: PALM DESERT, CA 92261
By: DANIEL P. CRAWFORD
Date: MAY 29, 2002
POST IN A CONSPICUOUS PLACE