SFD (0204-121)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
201103 B C-36 012 H1 11 1 M 0J2 r.1
,bate f t 7.
^` 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 1.
( ) 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:
Carrier 0°jATE FUND Policy No. 1371AX35
(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:c L, Y, 4,r4Applicant ��
t
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimin.'al 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 mentione roperty for inspection purposes.
Signature (Owner/Age tj ,•�- �•_ t t+ Date
� � b W
BUILDING PERMIT PERMITp n
El2t3�3• lr.:�;Y
DATE f { VALUATION 7190' LOT TRACT BLIX ;18 11.
JOB SITE ADDRESS . Q ,„�R A 1gR)A Y`�„( K.VI�i eco"'
APN 773-181-=
OWNER
CONTRACTOR/DESIGNER/EN (NEER
JAWS ��''NAP
3"IE 1 C. BIKKU r , JR,
PO DOX V1
73«300 YZI)�F-1 ax M1?
MA LUMPAX Ct, 922,61
rlfij�14_ D. MW CA 922,63
USE OF PERMIT
, CII;.F.:i^:E�w"Y
s3sv � 1�3�..I2:M1�,701sS ��r�'r rtv�:a-;von: ���C3� •��7� t.I� we?C,�f,, Cit ����1'��r�%Y
l�til�Zdab,�CFI, 3' i31�.Is AiA :t' 1694 02Y, KASTI RA, ftol,
TUICT CONSTIIC TI OAS' 1604.00 SP
ICI A 11.00 Sir
�P}OA TF:111-^taltPtpt1,
R. d�aF41?d7i'A1.1"1.79.a"�i7Yi,:i 420.00 CA
420.00 CAP
5 rr. WOOD PENCE s3n.g0 Z.1'
Z�'a�.it.�AI ) WV pax, COINS�`.�UMON
9719 0-143
ikU`aSPWr FEE SUNWARY
CONSTRUCTION FEB 101-000.41 CL -001 $631150
VR3 DEPOSIT 101.000-439-318 4230100
kt RC HMIC".AI,, YEF 101-0(*r-421-000 53.50
ELECTIUCAK, RE 101-000-420.000
PL.t1MB3t O "Irs 101-000.41 S "0000 $116.75
.C»C9 J1�'I`Ic'�Ai F - kNo j 1101-00441K000 � v,'?�
G11AD1140 IMF 101-000-X123.000 00:00
Di"M :LOP .IMPACT FEE
PRECISE PLAN $,300.00
z
Ig siJ :-`l°
06
.+"a3y490"
APP ?3 2O(1 t ,IT -,A -TA 11M?_WT FET— S VWX NOW
t-POELAQWWA
0MANCEDEPT
r
-
RECEIPT
DATE
BY `" 4 ".�
DA E FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings .D Z
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck - ( '-O 2
Exhaust Fans
O.K. to Wrap -7- p Z
F.A.U.
Framing Q .D Zi o?.
Compressor
Insulation .�
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�G � ZU
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 (�
Heater Final
_ _
Water Piping (o Q
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection4 L7. O y
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Finalr
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) - p
COMMENTS:
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 4/23/02
No. 23157
CERTIFICATE OF COMPLIANCE
APN # 773-214-019
Jurisdiction La Quinta
Owner NameJames Belknap
No, 52-175 Street Avenida Obregon
City La Quinta Zip 92253
Tract # BLK2U1 Lot # 8
Type of Development Single Family Residence
Comments
Permit # 0204-123
Log #
Study Area
Square Footage 1604
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 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 C. Belknap, Jr.
�: Telephone -777-9572
Name on the check �' r
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $3,432.56
Check No. 2111106
Signature ZL"
NOTICE: Pursuant to Ass ly 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 fro a date on which the building or installation permit for this project is sssued or on which they are paid to the Disbict(s) or to another public entity authorized to
collect them on the Distri )(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
RECORDING REQUESTED BY
American Title Company
AND WHEN RECORDED MAIL TO:
James C. Belknap, Jr.
32 Camino Arroyo Place
Palm Desert, CA 92261
A.P.N.: 773-181-022-9 TRA #: 020-016
Space Above This Line for Recorder's Use Only
Order No.: 27055125 Escrow No.: 02 -2308 -KY
GRANT DEED
THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $38.50
[ X ] computed on full value of property conveyed, or
[[ ]J 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,
William R. Riley., Trustee of The William R. Riley 1994 Trust
hereby GRANT(S) to James C. Belknap, Jr. Trustee of The James Belknap Separate Trust dated May 5 1992.
the following described property in the City of La Quinta, County of Riverside State of California;
Lot 10, Block 118, Unit 12, Santa Carmelita at Vale La Quinta, in the City of La Quinta, County of Riverside, State of
California, as per map recorded in Book 18, Page(s) 79 and 80 of Maps, in the Office of the County Recorder of said
County.
William R. Riley, Trustee of The
William R. Riley 1994 Trust
By: (Q 'we', -�..
Wtlltam . Riley, Trustee '
Document Date: March 5. 2002
STATE OF CALIFORNIA )SS
COUNTY OF RI V CY"-S)O-C )
On A44; a. % y Z va z. before me,
personally appeared L21 _ R,'l -e U.
personally known to me (or proved to me on the basis of satisfagiory evidence) to be the person(s) whose name(s) is/asasubscribed to the within instrument
and acknowledged to me that he/slt@Et executed the same in his/hopAhck authorized capacity(ies) and that by his/herLtheir signature(s) on the instrument
the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument.
WITNESS my hand andofficialseal. �j e&
Signature /)l^C`-` „`y j
C/
KATHRYN M. YA$1
KATHRYN . YASI U 1 COMM. x 1221410 area for official notarial seal.
M
V COMM. 1221410 (�} ; �- ' NOTARY PUBLIC -CALIFORNIA
NOTARY PUBLIC•CAUFORNIAG) RIVERSIDE COUNTY Q
A RIVERSIDE COUNTY Q oa COMM. EXP. MAY 25, 2003
,,,„ COMM. EXP. MAY 25, ' ax 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 per Section 9.50.090 of the Zoning Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any
house within 200 feet of the applicant, and/or 2) if there is a need for the applicant to file for
Master Design Guidelines. If the applicant does need to file a Master Design Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Belkna
SITE ADDRESS 51-955 Avenida Mendoza
APN 773 - 181 - 022 CASE NO.: 2002--638
LEGAL: LOT
10 BLOCK 11 . . UNIT
CHECK AND APPROVED BY: Martin Magana DATE:
S.C.@V.L.Q
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
Verify legal and APN information
Consistent with MDG on file (as
applicable
MDG filing required (5 filings since
9/3/98)
Architectural variety within 200 feet.of
Gl Ty OF I -A Of sill -,q
the surrounding area:
nLb,
Colors
RUILDirvua'Tv
Materials
Architectural design features
Pia
md •J;t s
ning Commbslort ..,...,..,,.
Other Requirements:
Co
! litials
ounc
mu it Dey. Dep4 oZ
. ,
ase t
-
to. 2 US
....,�
xhibit
W0
Conditions _..._..�.,.r. .._,_._
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: _ 51-955 AVENIDA MENDOZA
Use Classification: SFD Bldg. Permit No.: 0204-121
Occupancy Group: R-3, U-1 Type of Construction: V -N Land Use Zone: RC
Owner of Building: JAMES BELKNAP
Building Official
Address: PO BOX" -297
City: PALM DESERT CA 92201
By: KIRK KIRKLAND
Date: 10-7-02
POST IN A CONSPICUOUS PLACE