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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:- '