9512-027 (SFD)H
CV U)
TW
O 'D CM
^OLO
n c t`
Z n
O
cs,
F-
W Crp
�U CL
Z
LO
N
p)
d Q
o Z
LOFZccO
QW LL
J M
m: Q U
.0
airn H
�t Z
0
r` O
R
61:
tm LICENSED CONTRACTOR DECLARATION
,:I hereby affirm 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.gss3ls _a C30, 01196License # Lic. ass Exp. Date
Date % Signature of Contractor
OWNER -BUILDER DECLARATION !f
I hereby affirm 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
perform " of the work for which this permit is issued.
( have and will maintain workers' compensation insurance, as required by
Sec ion 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 CTATC G't ign Policy No. I'1 A2Af"0A.
(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.
Warning: Failure to secure Workers' Compensation coverage is u lawful 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 application agrees to, & shall, indemnify
& hold harmless the City of Indila''n-Wells 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. 1 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/Ager i) 1 . Date
""'
BUILDING PERMIT
PERMIT•
DATE 1'Y/j!)195
VALUATION $°91,414.010
LOT 22
TRACT BLK. 223
JOB SITE ADDRESS E.'N�
53-29.6 AVDA CARRANZA
APN
774-081-003
OWNER
CONTRACTOR
BELKNAP CONSTRUC r[.ON
JAMES C BELKNAP
77836 MONd'E2t MA
5"3292 AVENIDA CARR MIZA
IJ%. Q1JltKrA CA 92253
LA Q1.T1`NTt1. CA 97.253
(619)564-2793 C 13M0 2845
DESIGNER/ENGINEER
USE OF PERMITE+INU^U.1:AMILYDb' ELL,04
.ftnitit. does not. inclutla block wall or,Pual.
FEE DESCRIPTION
FEES
TRACT COINSi'RUCTION 1.475.00 Sl%
'PO11C"A'T'i0 75.00 SF
OARA.G&CARPORT 440.00 SF
6n, WOOD FEWE :00.00 Lk'
' S'TMIAT'Ejl9 LOST OF COiNS'MUCTION
91,414,00
PERMIT FEE SUMMARY
PLAN CIMCK F.E-1; 101-000-439-315 9511.05
CON.3TRUCTT.ON FEE 101-000418-000 $603.50
WCFIANICAL, F9E 101-000421.000 $S3.SO
EI.EC'17R:T,CAL :cEE 101-000-420--000 $1:33.93
PLUMBING FE:F: 101 -000 -419 -OW $140.73
GRADING FEE 101-000-423-000 $20.00
I-WRASTRUCI URE i2S-000-443-342 $1,996.12
PIRECIM, PLAN 101-000-441.345 $25.00
'FEE DEPT OSIT 4250.00
SUB -TOTAL CONSTRUCT ON .,AND (PLAN CHECK
$:3,473.55
LESS RRE-PA[U FEES
4250.110
TOTAL, Pf1,R r1' F'KES DIX NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r
INSPECTION RECORD
OPERATION DATE
INSPECTOR
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
G
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L.
j� ��_
7J
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drvmll - Int. Lath
I
Final
Set Backs
Footings
Bond Beam
Final
BLOCKWALL APPROV
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Final
Utilitv Notice
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit ,
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power j
Final
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
Encapsulation
Final
COMMENTS:
POOLS - SPAS
Final
Utility Natice
TAtif
P.O. BOX 1504 APPLICATION ONLY
Building _ �j;z ). 1e� UINT CALLE CALIFORNIAESTAD9
Address �tv XJ LA QUINTA, ORNIA 92253 r
Owner rV K E
�J
Mailing vG �✓� { �n BUILDING: TYPE CONST. 1yQ� OCC. GRP.
Address V '�')q _C81_
A.P. Number,
Zi�p/.,'`�� ( Tel.
Legal Description
Contractor 4 r, Project Description
Address
Gily,
pG tt/C_ti i) t'/ Zlpf�!r Tem:
State Lic. r City
& Classif. (jam J Lic. # Sq. Ft.No. No. Dw.
Arch., Engr.,
Size 11410 Stories Units
Designer New ® Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby,affirm cin
that I am licensed der provisions of Chapter 9 (commencing with Section
7000) of DiI_
vision 3 of the Business and Profess/�onns Code„and my license is in full force and
effect. (! _r F CA CSC JC_-�l.JL,_4L di,i
SIGNATURE "--r7• DATE .
( jr OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business 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 PERMIT AMOUNT
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 Plan Chk. Dep. Do
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
1] I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech.
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 Electrical
of proving that he did not build or improve for the purpose of sale.)
I I I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strucI the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
doesnot apply to an owner of property who builds or improves thereon, and who contracts for S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
1-7 l am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) 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_Owne
NOTICE TO APPLICANT:r If, after making this Certificate of Exemption you should become ZONE: BY:
y,. subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
X comply with such provisions or this permit shall be deemed revoked.
Front.Setback from Center Line
Rear Setback fromiRearVrop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback om Ce.. er Line
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.) Side Setback fro rope - ne
Lender's Name
Lender's Address FINAL DATE �INS%E-TORE”
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. Issued by: Date I Permit v
I agree to comply with all city and county ordinances and state laws relating to building r
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes. Validated by: ���7 /
Signature of applicant Date
Mailing Address Validation:
" City, State, Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL; SO. FT. @ $
UNITS
COLL. AREA
2ND FL:' SO. FT. C
YARD SPKLR SYSTEM .
POR. - SO. FT. n
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET. _
ROOF DRAINS
CAR P. I SO. FT. 0
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. 0
DRINKING FOUNTAIN
. SQ. FT. �
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISHi
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
4SHOWER .
BOILER B.T.U.
SO. FT. @ c
BATH TUB
VENTILATION
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® IA c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE.
GAR. FIREWALL
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE :ANK
FORMS
,,may.Y:
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT:'
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
•'tl�FINAL INSP.
ROOFING
;. .
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG NATURESIINITIALS
GARDEN WALL FINAL
Document Cannot Be Duplicated
desert Sands Uniiie(d Schooi aDistrict
82-879 Hiphwav H!
Indio-, CA 92211
C ERMFFICA a E OF C;C)Tve P i A C: E
Date _N# i i %iyh ,A PN # %%4-t)tSI-t)I1_S
No. 14039 Turisdiction i .a. Quinta.
._
d)Pnrenit OwnerNameName James l:. lietKriap #
_
gar,.
53292 ct,ef Avenida Carranza Lag #
City La Quinta Zip 92253 Study Area 112
Tract # BLK.223 Lot # 22 Square Footage 1415
Tyne of Devei_opment Single Family Residence
By
No. of Units i
At the present time, the Desert Sands unified School District does not collect tees on
warages/carports, covered patios/waiicways, residential additions unser >UU square feet, detached
accessory structures or replacement mobilehomes. It has been determined the above-named owner is
exempt from paving school tees at ties time due to the tollowinp, reason:
EXEMPTION NOT APPLICABLE
This certifieC that school tar_.ility tees imposed pursuant to Government Code 53080
in the amount of 1.72 X 1,475 or $2,537.00
the property listed above and that building permits and/or Certificates of Occupancy for
this square toota-ae in this proposed prolect may now be issued.
Fees Paid By .lames C;. tSeiknna, Jr.
Name on the caecic
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
r'
_ rr
Ieiepnone
Payment Received $2,537.00
(:heck No. 2081
Coliector: Attach a copy of county or city pian check application form to district copy for all waivers.
Embossed Original- Building uent.iMpiicant t=V - AADlicant%Keceipt CoAv - Accounting
JAMES O. WALLACE
Agricultural Commissioner
Director of Weights & Measures
OFFICE OF THE
AGRICULTURAL COMMISSIONER
P.O. BOX 1089
RIVERSIDE CA 92502-1089
PHONE (909) 275-3000
FAX (909) 275-3012
83-612 Avenue 45 Suite 7
Indio, CA 9220.1
(619)863-8291
DATE -2 0 5 CASE NO. //20
DEVELOPER'S NAME:'
I J L l Ih VAGI I7 V B (L J �r U G 16 0 V\
ADDRESS: IloI
TELEPHONE: 5 l L�.,, 2-� 0o I
Dear Developer:
CALVIN C. KAMINSKAS
Assistant Conrr6sloner
DAN RILEY
Sealer, Weights & Measures
(909) 275-3030
FAX (909) 276-4728
,62-- 00 e ra vL vj �z_a S fr , r (X V k �+a
After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
.:do occur and they differ from plant material listed, this office must be
notif.ied immediately.
Thank you for protecting and preserving the Coachella Valley's pest -free
environment.
C
cultgral Commissioner's Office
In4lio and Riverside
F'i5-47� 4 * 'T r" it;
EARTH SYSTEMS CONSULTANTS S.C.
79-811 B Country Club Drive
Bermuda Dunes, CA 92201 • (619) 345-1586
-01 =W.
CLIENT NAME
CLIENTADDRESS
CLIENT PHONE
DATE JOBNO.
t� ST_ p
PROJECT
c(/4uULC,
LOCATION
CONTRACTOR CVIIPHi .
A 10I s
WEATHER
c � /too I
TEMP TIME
PRESENT AT SITE
�II
of
or." -r*
,` u
Tit� of 14a Outonta
�uiin� �tn� s�'Sr�fet�r �iion
This Certificate issued pursuant to the requirements of Section 306 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 53-280 Avenida Carranza
Use Classification Single Family Dwelling Bldq. Permit NIO. 9512-027
Group R-3 Type Construction `7N Fre Zone Use Zone R-3
Owner of Buildinq James C. Belknap Address
La Qui ta, CA., 92253
By; —
��� Dots: _
Building Official
POST IN A CONS}ICUOUS PLACE
Daniel P. Crawford Jr.
May 28, 1996