9676 (SFD)44a
. P.O. BOX 1504. N o . 9676
Building 78-105 CALLE ESTADO
Address 51-345 Avenida Rubio LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address P. 0. Box. 1062
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Lot 9 Block 48
Project Description SFD
City
La QUir_ta
Zip
92253
Tel.
Contractor
Owner/Builder
Address
City
Zip
Tel.:
State Lic.
City
"
& Classif.
Lic. #
Sq. Ft.
Size 1831
No. No. Dw.
Stories Units
Arch., Engr.,
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Designer
Address
Tel.
Permit does not include block wall or
City
Zip
State
Lic. #
X01
�. 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. \ :\ i : 1: Al I `.. t \I:. ra
,
.SIGNATURE 4 i •.T `►-.. -.- " - DATE
OWNER -BUILDER DECLARATION i
I hereby affirm that I am exempt from the Contractor's 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
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 ($500).
O 1, 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.)
Estimated Valuation
105.778.30
PERMIT
AMOUNT
Plan Chk. Dep.
.250.00
_
Plan Chk. Bal. f
313.41
Coast.
r
�9� �
Mech.
2+� 0R0
G . L :!
Electrical
_
13
Plumbing
16 . S Q
O' I, as owner of the property, am exclusively contracting with licensed contractors to con-
stct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
S.M.I.
•� n
10 r J 4l
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.)
❑ I am exempt under Sec. B. & P.C. for this reason
Grading
afi_ 0Q
Driveway Enc.
20.00
Date Owner
Infrastructure
2296.67
Art in Public 25.00
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
3960.87 3710.87
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
REMARKS.
(This section need not be completed If the permit Is for one hundred dollars (8100) 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.
,,
_ t ti�t6 , + G }
d it O,# S''t
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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
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 properly for inspection purposes.
Issued by:
Validated by:
Date Permit
Signature of appllcanL Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. $
2ND FL SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FJ ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® IVi c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 31Lc
HOUSE SEWER
��ryyy
FINAL INSP. �f
7
ROOFING ` /
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK a
ROUND PLUM BINC0-111pl
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
/
GAS (FINAL) 9
"
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
-$
LUMBER GR.
FINAL INSP.
FRAMING 7�0
��ryyy
FINAL INSP. �f
7
ROOFING ` /
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 4 7
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
.82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 6/10/91
No. 10647
Owner Name
Type of Permit
Jim Belknap
No. 51345 street Avenida Rubio
city La Quinta zip 92253
La Quinta
Permit #
Log #
Study Area 114
APN # Tract # Lot # Square Footage 11831
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 11.58 1 X 1831 or $ 2,892.98 have been paid to D.S.0 S.D. for
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 R.R. - J.B. Building Fund Telephone 564-2605
Name on the check
By Richard M. Beck
Director Facilities Planning & Development
+,
r 4
Fee collected /exempted by Shelley D. Bennett
Payment Received'
Signature'
f \,
ch'o-c ti No. ;i 05
Collector: Attach a copy of county or city plan check application form to district;,g4y for.. all ws ve`rs.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounti g � ?-.
Order No. C526537
Escrow No. 2-12169-DE/JB
Loan No.
WHEN RECORDED MAIL TO:
Mr. and Mrs. James C. Belknap, Jr.
73-300 Fiddleneck Lane
Palm Desert, CA 92260
MAIL TAX STATEMENTS TO:
SAME AS ABOVE
PERTIF�ED TO BEA TRUE AND (0RRECr CBPY.0F
THE 0 161gAL
SITE ESCROW, IRC, ,
By
SPACE ABOVE THIS LINE FOR RECORDER'S USE
LXXUrWENTARY TRANSFER TAX $....eft.: Vie' :......... .................
X.... Computed on the consideration or value of property conveyed; OR
...... Computed on the consideration or value less liens or encumbrances
remaining at time of sale.
Signature of Declarant or Agent determining tex — Flrm Neme
t
CORPORATION GRANT DEED
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged, BALDHO,SWy ENTERPRISES,
INC., a California Corporation
a corporation orcanized under the laws of the State of
California. ,does hereby
GRANT to JAMES C. BELKNAP, JR, and JACQUELYN BELKNAP, husband and wife as community property
the real property in the City of La Quinta
County of Riverside State of California, described as
Lot 9 in Block 48 of SANTA CARMELITA AT VALE LA QUINTA, Unit No. 4, as per Map recorded In
Book 18, page 62 of Maps, Records of Riverside County, California.
Dated May 20, 1991
I
STATE OF CYQWAMA U6EX§DA Iss
COUNTY OF-----!:fU I
On May 21, 19 9 i before me,
the undersigned, a Notary Public in and for said State, personally appear-
ed Raymond Baldhosky
and
personally known to me (or proved to me on the basis of satisfactory
evidence) to be the persons who executed the within instrument as
President and
By r car+-- ii
Raymond Baldhosky
By
ancie�ary,
e-ewe-w�se
on behalf of
BALDHOSKY ENTERPRISES, INC. OFFICIAL SEAL
ARLENE E. LAUER
NOTARY PUBLIC • STATE OF NEVADA
Secretary
the corporation therein named, and acknowledged to me that such cor- • ' DOUGLAS COUNTY
poration executed the within instrument pursuant to its by-laws or a
My commission expires FeO. 28. 1904.
resolution of its board of directors.
WITNESS my handand official
seal. n �,
Signature_n �X d�`�' `'' , � ---- (This area for official notarial seal) 1144 fs/82)
MAIL TAX STATEMENTS AS DIRECTED ABOVE
f` JU19 11 51 0?:53 TRPr)F1.1RF.K`l'ti`I:.•.-r—TMill r F'. 02 s
�- tQA� p
• K . � ,; a "- i • . � ,
LINE
46
6' RLDCK
WALL 71.
NOTE
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