04-5273 (SFD)BUILDING & SAFETY DEPARTMENT
P.O: Box 1504-
(760).77,777012
78495 CALLS TAMPICO FAX (760) 777-7011
LA .QUINTA; CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 04-0'0005273 'Date .6/30'/04
Property Address . . 52615 AVENIDA RUBIO
APN: 773-282-018-. - -
Application description DWELLING.:- SINGLE FAMILY.DETACHED
Property Zoning,. :COVE:. RESIDENTIAL
Agplcatori `valuation 10'2047
i
Owner Contractor
BELIMAP: JAMES. C-...
C./O-•JAMES BELKNAP .SEPARATE .TRU P`.0'. BOX 29<7.;
32 CAMiNO ARROYO: :PL ': PALM: -DESERT' CA :92261..
•
PP,LM-DESERT. CA,.922.60(760)< 837-.•1566
:. ....... .
WCC.'STATE FUND
:.WC:.' .157.678.5 1.0/01/04
. :. CSLB: 2.0503Y 11.(30/
05
C
----------- -----=--------- Structure Information ------ _-----
Construction Type TYPEV - NON"RATED
Occupancy Type. DWELLG/LODGING/CONE <=10
Flood Zone NON AO FLOOD ZONE
Other •struct info CODE ,EDITION a 2001..CBC
##" .BEDROOMS`; 3 ; p 0
FIRE::SPRI'NKLERS NO
GARAGESQ FTG 446.00.
F
PATIO µSQ ..FTG 117 00 .
NUMBER= -OF' UNITS 1.00
FIRST_: FLOOR. SQ' FTG.. 1604.00
-
----=-------------------------- -- -- --r -- -= ------------
Permit BUILDING PERMIT
:.Additional de'sc
Permit Fee. 650.00 Plan .Chec} Fee . 422,.5"0
Issue.Date . . Valuation 102047
Qty Unit -Charge Per Extension
BASE FEE 639.50
3.00 3.5,000 THOU BLDG 100,001-5.00,000 10.50.
Permit MECHANICAL
Additional desc
Permit" •Fee ' : p an Check Fe.e 14.75
(}
Issue Date U �U��Ia�luation 0
.. �,�1,� 302
004:. U
Qty Unit Charge PerExtension
�... CIT.Y. &Urd OTA
P.O. BOX 1504 - • /i ,
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QutNTA, CALIFORNIA 92253 FAX
(760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: CAI 527 �3 Date: !o -gm' m
Applicant: I Architect Or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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 ss 11
License ys;full force end effect
License CIas3 License No. �Z So 3
Date — Contractor
O ER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the ContractW State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she 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.($5W).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does ft work
himself or herself or through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
() 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not.apply to an owner of property who builds or improves thereon.. and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
.(J I am exempt under Sec. BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4risure for workers' compensatidn, as provided for by Section 3700 of the Labor Code, for the
,perfommance "
of the work for which this permit is issued.
T I have and will, maintain workers' compensation insurance, as raquired by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Cartier suegd. l ��s�pon insurance carrier an policy numb arra
'� V Policy Number ��'7A- � os
_ I certify that, in the Oerforman6e 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 (o Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE I UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affmrn under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is Issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
i. 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, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to work being performed under or following issuance of this permit
2. Any pemmlt 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 withall city and county ordinances and state laws relating to building
construction,
and hereby authorize. representatives of this county to ent the boned property for inspection purposes.
Date — ?� Signature (Applicant or Agent):
Issue Date
Qty Unit Charge Per
BASE'FEE
Special Notes and Comments
1604 S.F. SFD PERMIT DOES NOT INCLUDE
0
Extension
15.00
Page
2
Application
Number
04-00005273. Date
6/30/04
Qty
Unit Charge
Per
Extension
',,BASE .FEE
15.00
1.00
0.0 0,0
SEA
MECH FURNACE <=100K
9.00
1.00
9. 0000
EA �
MECH B%,C-<=3HP/100K Bt -U.
9.00
3.00
6.5000
EA
MECH VENT FAN:
19.50
1.00
6.5000
EA
•MECH.Ek AUST HOOD
6.50
Permit
ELEC-.NEW
RESIDENTIAL
Additional
desc
Permit°Fee
..95.06
Plan Check Fee
23.77
Issue Date
Valuation . . . .
J
0.
Qty
Unit Charge.
Per
Extension
BASE EEE
15.00
1604.00
.0350
ELEC NEW,RES' - 1.OR 2 FAMILY
56.14
4.46'.00
.0200
ELE;C`, GARAGE OR NON-RESIDENTIAL
8.92
1.00
15.0000
EA
EIEC TEMPORARY POWER POLE
15..00
Permit
PLUMBING,
Additional
desc
Permit Fee
123.00
Plan Check Fee
30.75
Issue Date
. . .
Valuation
0
Qty
Unit Charge
Per
Extension
BASE FEE'
15.00
9.00
6.0000
EA
PLB FIXTURE •
54.00
1.00
15..0':000
EA,
PLB BUIL.DING-SEWER.
15.00
1.00
75.000,EA'
PLB'WATER HEATER/VENT
7.50
1.00
3.0000
..EA
'PLB-WATER INST/ALT/REP"
3.00
1.00
9:0000.
EA
PLB LAWN -SPRINKLER SYSTEM
9.00
6.00
7 5,0 0
EA
PLB GAS PIPE >=5 '•
4.50-
1.00
15.0000
EA
PLB'GAS METER
15.00
Permit
:GRADING
'PERMIT
Additional
desc
Permit Fee
15:.00. Plan- Check' Fee
.00
Issue Date
Qty Unit Charge Per
BASE'FEE
Special Notes and Comments
1604 S.F. SFD PERMIT DOES NOT INCLUDE
0
Extension
15.00
Page
3
Application Number
. . . . .
04-00005273 Date
6/30/04
Special Notes and'Comments
BLOCK WALL, POOL/SPA
OR.DRIVEWAY
APPROACH
------------------------
Other Fees . . .
------.------
. . . . .. .
-----f---------------------
ART ISN PUBLIC PLACES -RES
--------------
.00
DIF COMMUN-I'TY;CENTERS-RES
97.0.0
DIF CIVIC_=CENTER. - 'RES
366.00
.ENERGY REVIEW FEE
42.25
`:DI>F.FIREFROTECTION.-RES
97.00
GRAD3NG :PLAN; CHECK. FEE
00
DIF'LIBRARIES - RES
225.00
D'.IF PPARK 'MAINT FAC ; - RES
5.00
DI,F,PARKS/REC - RES
502.00
COVE -..PRECISE. 'PLAN. FEE
100 . 00
S'T'RONG .MOTI.ON.:.'(SMI) - RES
10.20
.,DIF STREET MAINT FAC -RES-
15.00
TRANS - RES
1098.00
Fee summary.
Charged
Pail d Credited
Due
Permit Fe'e Total
:942..06
.00 .00
942.06
Plan Check Total
491`:77
..00 .00
491.'77
Other Fee Total
25,57..45-
.00 .0.0
2557.45
Grand Total
3991.28
.00 .00
3991.28
t j .:UN 30 2904
i.
CITY OF L.A CBIEINTA
FINANCE Dd=PY.
1
Certificate � f ccupancY
0 .
Tw-
';
f �' LcoKroenry 0.4
I;
E G 9�5
�oF Building:, � Safety Department
L
# t
t This Certificate is issued pursuant to the 'requirements of Section 109 of the California Building
E
E
Code, certifying, that, at the time of issuance, this structure was in compliance with the
•.
a k
provisions . of the Building Code and the various ordinances of the City regulating building
I r
construction and/or use.
Ec
E BUILDING ADDRESS: 52=615 AVENIDA RUBIO
ti
I
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04=6273
k
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: RC
I
Owner : JAMES C. BELKNAP Address: 32 CAMINO ARROYO PL.
of Building
s
City, ST, ZIP- PALM DESERT, CA 92260
By: KIRK KIRKLAND
Date: NOVEMBER 30, 2004
Building Official
POST IN A CONSPICUOUS PLACE'
t
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that schoolfacility fees imposed. pursuant. to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.24 X 1,604 S.F. or $3,592.96 have been paid 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 CC=La Jolla Bank=Doug Belknap Check No. 800526
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Beth Schieferstine Payment Recd
$3,592.96 Over/Under
Signature
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date o�which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building DepartmenUApplicant Copy - Applicant/Receipt Copy - Accounting
�--o'-H nw-Requested By.
<ii r[fle Company
RECO DfIV(1rY3EQUEiIiED 8Y:
.Fidelity Yatioriallitle Company
Escrow No 411064 -CB
Title Order. No.
When, Recorded MailaDocun ent
and Tax Statement To: + A0
Mr. J.C. Belknap:
32 Camino Arroyo y Vof
Palm Desert, CA 92260
52-665.AuP Acuar'41>
t Pf$
20"03-976876
12/]5%2003�0a,: 0' Fee:10.e0
P44i 11•of 2"„DoccT Tax Paid
Recorded 16.6ffi6ial Records
• County. of?Riverside
Gary L. Orso
Assesmor.,,County'.14rk,8 Recorder
- I Illlll illlll !IN IlIIIIiIII INlll 11111!1 Nl�llfll IIID Illi
--- MNVINEET
The undersigned-grantor(s) declares)
Documentary transfer tax Is 3253:00 Lo r= 9 I
k [ X I computed dn-Jull value of property conveyed or
�► [ ) computed'on`full,value less value'of liens orrencumbrances remaining,a times& sale, LSU
[ ) Unincorporated Area Cityof La Quinta
FOR A VALUABLE CONSIDERATIONS receipt of whichA',`hereby acknowledged, Frank Myrl Griswold, Successor
Trustee of The Henry Griswold Living Trust dated,June. 19, 1995
•hereby GRANT(S) to J.C. Belknap General Contractor, a General Partnership
the following described real property in,the City of,La Quanta
County of Riverside, Statezof California:
SEE EXHIBIT ONE ATTACHED HERETO AND`MADE A PART HEREOF
DATED: November 6, 2003
STATE OF CALIFORNIA
COUNTrY OF Mair
ONs,4 S ::'before me,
v A' • bran ” personally appeared -
personally known to me (or proved tome on the basis
of'satisfactory evidence) to be the; person whose
namaKis/ace subscribed to the withininstrument and.
acknowledged to me that he/s gAlj�y executed base
same in his/1%r/thbir authorized capacity(ies),, and that
by his(h�rltlikir signature ) :on the instrument the -
or the entity .
person dY upon .behalf of which the
person( acted, executed the 'instrurrient:
Witness my hand and official seal.
Signature
FO -213 (Rev 7/96)
MAIL TAX.STATEMENTS
' -GRANT~C
Frank Myrl Griswold -,'
Trustee of The Henry
Griswold Liyin rust dated June , 1995
Frank My' i( Griswold, uste
LINDAA. GAGNON
Commission 1.1313093
=a; Notary Public- Cai romis z�
Orange ;Couhty
My Ccrrrn. F-Vlres Jul 13, 2005
DIRECTED ABOVE
Description: Riverside, CA Document -Year. Dock) 2003.976876 Page: 1 *of 2
Order: mike Comment:
�o■�ir�-ew����
MMINIMMMMMMM
--- MNVINEET
The undersigned-grantor(s) declares)
Documentary transfer tax Is 3253:00 Lo r= 9 I
k [ X I computed dn-Jull value of property conveyed or
�► [ ) computed'on`full,value less value'of liens orrencumbrances remaining,a times& sale, LSU
[ ) Unincorporated Area Cityof La Quinta
FOR A VALUABLE CONSIDERATIONS receipt of whichA',`hereby acknowledged, Frank Myrl Griswold, Successor
Trustee of The Henry Griswold Living Trust dated,June. 19, 1995
•hereby GRANT(S) to J.C. Belknap General Contractor, a General Partnership
the following described real property in,the City of,La Quanta
County of Riverside, Statezof California:
SEE EXHIBIT ONE ATTACHED HERETO AND`MADE A PART HEREOF
DATED: November 6, 2003
STATE OF CALIFORNIA
COUNTrY OF Mair
ONs,4 S ::'before me,
v A' • bran ” personally appeared -
personally known to me (or proved tome on the basis
of'satisfactory evidence) to be the; person whose
namaKis/ace subscribed to the withininstrument and.
acknowledged to me that he/s gAlj�y executed base
same in his/1%r/thbir authorized capacity(ies),, and that
by his(h�rltlikir signature ) :on the instrument the -
or the entity .
person dY upon .behalf of which the
person( acted, executed the 'instrurrient:
Witness my hand and official seal.
Signature
FO -213 (Rev 7/96)
MAIL TAX.STATEMENTS
' -GRANT~C
Frank Myrl Griswold -,'
Trustee of The Henry
Griswold Liyin rust dated June , 1995
Frank My' i( Griswold, uste
LINDAA. GAGNON
Commission 1.1313093
=a; Notary Public- Cai romis z�
Orange ;Couhty
My Ccrrrn. F-Vlres Jul 13, 2005
DIRECTED ABOVE
Description: Riverside, CA Document -Year. Dock) 2003.976876 Page: 1 *of 2
Order: mike Comment:
Escrow No. 411064•C8
Title Order No.
. � 'EXHIBIT ONE
Lots. 8, 9 and -10; Block X164 of;Santa.Carmel+ta at -Vale La:Quirita, Unit"�i17, as per map recorded in Book 19; Page
19 of Maps, in the Office; of',the County Recorder of said` County.
known as: APN #773=283-021-3, #7,73-283 022-4,.#77- ..-28,3=023-5
Lot 51 Block '165 oUSanta Carmelite at Vale La Quints _Unit`#17, as per map recorded in Book 19, Page 19 & 20 of
Maps, in the Office of the County Recorder of sai8tounty.,� _ ` '
known as: APN #7737282-018.z8
•�15 )�s�.: ��6•B
Description:, Riverside; CA Document=Year DoclD 2003:976876 Page ;2.bf 2
Order.- mike`Comment:- '