9604-031 (SFD)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 ti Exp. Date .
Date t (t !,, Signature of Contractor �,• f�r �. �_ _ `'`
OWNER-BUILDER*IDECLARATION �i
I hereby affirm under penalty of perjury that,l am exempt from the Contractor's
License Law for the following reason` `� ... '_11.
( ) 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 c$rrier &,rpqlicy no. are:
Carrier 8 FA V.111, e" ")i�fLi Policy No. 1?'i•lf 649
(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 oflCalifornia, and agree that if I should become
Subject to the workers' compensation provisions oPSection'3700 of thetLabor
,Code,rl shall forthwith comply withthose provisions. ( „ t
Date: t t f (. Applicant �R ti �.. ...
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,'in
addition to the cost of compensation, damages is provided for'�in Section 3706
of the Labor Code, interest and attorney's fees. `'
IMPORTANT Application is he made to the Director of Building and Safety
for a permit subject to the conditions 'and restrictions set forth' on his
application.
1: Each person upon whose behalf this application is made & each person a.t
whose request and.for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I a ree to comply with all City, and State laws relating to the building
construction\ and hereby authorize representatives of this City to enter upon,
tt e: above-mentioned property for inspection purposes.
• y r �. r
Signature (Owne 1,Agent)`t}• _I Date "fri `f
BUILDING -PERMIT . PERMITk -� CONTROLN
g
3086
DATE VALUATION LOTTRACT
4/11/9
JOB SITE
ADDRESS .E «r. .� M1 . 4
�4-�Jiiy 4.l�t�iEai� l,f�.h�C[1iM
APN ,
Rv
OWNER
CONTRACTOR/DESIGNER/ENGINEER L
. .S �
' P
)E110JnONI40ON
�%
(�?9�S1 •2?; 3 CRL -0 2M5
USE OF PERMIT
yYNGL E l=riAMY OWE1 1.:ING
1 F14ATIT DOES 110:!')t`Y(JL UM, SL CK WALL 01;t P001—
`11AC Ci �tdS:iRUC1ION 1,�ilft.fiCi
K)lZL`Wl?ATK) 1k.fjo SZ
4'tARAWCAlkPORT 41;KfN3 Sig
%..ST_d.NxA.i ED CUST OF CCDI9rS'$'4':.4ICTION'
�1i,3{gi.iltl
FUN .rMIOSIT
MANIC'MI C"K FE:E 141-000-439-11.� . 151:K91
Ci'crtilolTRUC.LION 1133 Itl1'Qtt(1-q'.13�i}tll� �� f.Cf�
SY1]"Stlitit+f)C;A6:'F�'Trl's 3til�3�U��1�1-t1C1(} t.tiU
RLECl'j11CA:(..,E1K?'d " .104-f21V420.000
i31.�.'A973i1dGFa�: ?C'!. fH}p•�11�-!u� $t�?'.SrJ
la 1 i11+IC's i�i0"e':l�' Id'Iii#6 •• %13S l.r I ll i -{)00.241-'000 $9.80
CAli- RAS IRI,, k:;11 UC:40i- ;1 2 —6.000-=143-342
f?:itir,'t;�1:1°I,A`tf i41t�1.)t►t)-�iAl-;��lS �;ry:4.GU
,.. - 5Tf �'f C S'1"12.uctiON, A- M) PUN � 4J.,''CK
$3,401, 6
LESS .P1d1 -Pill) P ITS
4250.00
',D 1996 A Trl1, t'Eiiff r,KES 1) U ENO
fi3,.tS .hC
ApR'11
RECEIPT
DA E
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPR VALS
MECHANICAL APPROVALS
Set Backs 41V
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel 7
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor -
Insulation
Vents
Fireplace P.L.
Grills
Fire lace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. LathILI
Final
Final
POOLS - SPAS
BLOCKWALL'APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PJbg. Test _
Final
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 LateralPool
Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test /
Appliances
Final
COMMENTS:
,�i, /�� `I�' — %el �o 55GCj
l
Final
Utility Notice( Gas).
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring�fj/,/f�
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
82-879 Highway 111
Notice: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/11/96
No. 14322
Owner Name James Belknap
No. 54965 Street Avenida Carranza
City La Quinta
Tract # Lot #
APN # 774-294-023
Jurisdiction La Ouinta
Zip 92253
Permit #
Log #
Study Area 110
Square Footage 1410
Type of Development Single Family Residence No. of Units 1
Comments
By
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 1.72 X 1,410 or $2,425.20
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 James C. Belknap, Jr. Tele0ione'
�`
Name on the check `
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received $2,425.20
Check No. 636
Signature u
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dent./Applicant Coov - Applicant/Receiot CODv - Accounting
AF ItAV * �
30 Day Temporary
of
(jprr-T-P-%� -
30 Day Temporary.
Tt*tLt of 1a (Ouinta
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:
54-965 AVENIDA CARRANZA
BUILDING ADDRESS
Use Classification SINGLE FAMILY DWELLING Bldg. Permit No. 9604-031
Group R-3 Type Construction VN Fire Zone Use Zone SR
Owner of Building JAMES C. BELKNAP, Jr. Address 73-300 FIDDLENECK LANE
City PALM DESERT, CA., 92260 Daniel P. Crawford Jr.
By•'
October 2,. 1996
Date;
Building Official
/O!T IN A aoNeltCUOu! /LACI
NOTL:
With proper validation
this form constitutes an CITY OF LA QUINTA
encroachment permit
APPLICATION FOR PERMIT
PUBLIC WORKS CONSTRUCTION (ENCROACHMENT)
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, sewers, water mains
and other like public works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS
Subdivision Improvement Permit — Class I II
DATE: April 26, 1996 Minor Improvement Permit Class IV
LOCATION OF CONSTRUCTION S 54-965 Avenida Carranza----------------------
(Street address or Description of Location) ZAP
.. ,� .
t, PURPOSE.OF CONSTRUCTION Grading and Site
Improvements
DESCRIPTION OF CONSTRUCTION Retaining/block wall
DIMENSION OF INSTALLATION OR REMOVAL 71
SIZE OF EXCAVATION, IF NEEDED N/A
APPROXIMATE TIME WHEN WORK WILL BEGIN 4/26/96 "
APPROXIMATE TIME OF COMPLETION 4/29/96
ESTIMATED CONSTRUCTION COST $
(Including removal of all obstruction, materials, and debris, backfilling, com-
paction and placing permanent resurfacing and/or replacing improvements)
In consideration of the granting of this permit, the applicant hereby agrees
f
Sketch (attach construction plans if appropriate)
See attached drawing
See attached conditions
Indemnify,defend and save the City, its authorized agents, officers, representatives and emplo��ees, harmless from and against any -Ad all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or p perty
happening or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of
La Quinta and to pay for any additional replacement necessary as the result of this work.
Signature of Applicant or Agent
Belknap Construction P.O. Box 297 La Quinta, CA 92253 (619) 564-2783
Name of Applicant (please print) Business Address Telephone No.
Same
Name of Contractor and Job Foreman Business Address Telephone No.
652815
Contractor's License No.
2845
City Business License No.
Applicant's Insurance Company Policy Number , :nl /Ls\
FEES: Subdivision Improvement Permit — Class 111
Public improvements: 3% of estimated construction costs
Private improvements: 3% of estimated construction costs
Minor Improvement Permit — Class IV: See attached schedule
Inspection Fee
Permit Fee
Penalty
Cash Deposit -Surety Bond
if required
TOTAL:
Receipt No.
Received by
Recorded by
$ 20.
10.
$ 30.
Date
fAPR 2 D 1996
t
2.454. _
PERMIT VALIDATION
PERMIT NO. 2454
DATE APPROVED
4/26/96
EXPIRATION DATE Indefinite
DAE ISSUED 4/26/96
By
Administrative Authority
TELEPHONE: (619) 51@40,6 777-7075
JAMES O. WALLACE
Apricullurol Commissloner
01reclor of Welphts & Measures
OFFICE OF TI IE
AGRICULTURAL COMMISSIONER
P.O. BOX 1009
RIVERSIDE CA 92502-1089
PHONE(9M)276-3000
FAX (909) 271-3012
83-612 Avenue 45 Suite 7
.Indio, CA 9220.1
(619)863-8291
DATE // / CASK NO. C/--Ucfo�c/(o
DEVELOPER'S NAME: �' ��C o Co k s 7Ld�c 7/r''a vc_
ADDRESS: X 7
C.4
l
CALVIN C. KAMINSKAS
AssIsIont Commissloner
DAN RILEY
Sooler, Weights & Measures
(909) 276-3030
FAX (909) 276-4728
TELEPHONE:
:
Dear Developer:
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.
notified immediately.
Thank you for protecting and preserving the Coachella Valley's pest -flee
environment.
Agricultural Commissioner's Office
cc: Indio arid Riverside