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0401-105 (SFD)LICENSED CONTRACTOR DECLARATION 1.,,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 9 Exp. Date 205031 13 'C.46 N. 1.1I � ( 11 /111, 0/2( � ;!4 Date -> ' ? Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under, penalty of perjury 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 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 carrier & policy no. are: Carrier STATE Cri',IND . Policy No. 1576183 (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 i subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall,foithwith comply with those provisions. fa Date: -" ti,N Applicant- _�_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 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 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 tiort- I certify that I have read this application and state that the above i .Etf) :on is[,� correct. I agree to comply with all City, and State laws relating to ullding construction, and hereby authorize representatives of this City t n r upon the above-mentioned property for inspection purposes. FEB �Sig'nature (Owner/Agent) Date BUILDING PERMIT PERMI0401.405 - DATEV� LUATION 9979194e9�F LOT TRACT 16 S JOB SITE ADDRESS 52-655 A.1r:�.INIt)A 1:C�l�IO APN i 7:It•M-020 OWNER CONTRACTOR / DESIGNER / ENGINEER JAMn B. 3'"AP Je'U'ViIMll C. BET KNAP, JR. P.O. BOX 297 73-300 XDD1M4J_?C]K LAME PALIrt[:1'3ESEWl' CA 92261 PAi:f\ .DESYRI' t „k 92261 (76OY777.9572 C BLO 2905 USE OF PERMIT OW0 , F.W7 Y T�i1GI LLJI�TC9 1604 S.F. SPT), PER -MIT ]DOES NOT INCLUDE BLOCK WAL.I., POOLAPA OR DRIVEWAY APPROACH . TRACT CONSTRUCTION 1,604,00 Sp POkC HIPATIO . 11-7.00 9F 0ARA4NYCARP0RT 446.0013F $b7VdW1 J) CCAS' OF CONSTR ICrnON PERMrr FWE SUMMARY CONSTRUCTM-)N I;EE 101-000-418-000 PIAN CPIWX FEE 101-400-4:39-318 $526.57 FEE DEPOSIT 101-000.1139.3318 42Sf1.00 MECHANICAL ",E 101-000-421-0001 $65.90 ELECTRICAL, HE 101.000-42Un000 $113.56 PL,UMBIND FEE 101-000-419-000 $124.00 STRONG MOTION IEEE - P..ErSID 101-000.241-000 $9,74 Ll'�ING FZZ 101-040-423-000 $13.00 L TWELOPER IMPACT "Z9 $2,405,00 PRECISE PLAN 1.01-000-441-345 ^pi00.00 .`y'UB-TOTAL CONETRLYC'NON AND :PLAN CI -MC;. L1•.%' PRE -PAID FF. 0 -$250.00 TOTAL -Pk"-IT in—ELPS DTA" NOW C) 0Z&tIFZrJJ1JJ DATEBY V D FI L D O 7 INSPECTOR % INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 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 GLS Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath -I Final BLOCKWALL APPROVALS Final POOLS -SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Waste Lines Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection -_ ! � Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: �i(liyG Q�J` o L6 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) '0110 1-105 T4tvl 4 4Qw % P.O. BOX 1504 APPLICATION ONLY Building �'`�L/y LA QUINTA8-495 CCAL CALIALLE FORNIA ICO AddresA 92253 s Owner Mailing Address Y Contractor f Address / 1 ,��C. I I p�el� C ITel. _/ State Lic. City & Classif. Lic. # Designer "40. T.. Tel. :Y, 4)�_la- IZip ,�,U I��t# aosu3 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. SIGNATURE DATE OWNER -BUILDER DECLARATION 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 rile 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 or not more than rive hundred dollars ($500). I'] 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, Buisness and Professions Code: The Contractor's License Caw 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.) I'1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 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.) 17 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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 n Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (E100) valuation or less.) I certify that in the performance of ing 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 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. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name 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 1 have read this application and state that the above information is correct. 1 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 property for inspection purposes. Signature of a0pl Mailing Address - City, State, Zip - BUILDING: TYPE'CONST.QLOCC. GRP. A.P. Number Legal Description Proje Description 53-370 V Sq. Ft. No. No. Dw._ Size �� Stories % Units New b,-' Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. �Q7 Plan Chk. Bal. Const. Mech. Electrical ,. Plumbing S.M.I. lIU 41 GradingILI Driveway En#J p, -n Infrastructure V 11 1 TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Comments Overpayment of $32.08 to be used as donation." 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 accessorystructures'(spaces that do not contain facllities-for,.living; sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt frompaying school fees at•this time due to the'following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed:`pursuant td . t Education Code. Section 17620 and Government Code 65995. Et Seq. in the amount of .$2.14 X 1,604 ' S.F.' or $3,432.56 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/Palm Desert` Nat'l- Bank-James-BelKnap Check No. 088026 Name on the check Telephone Funding, Residential By Dr. Doris Wilson Superintendent Fee collected /exempted by Sharon, Gllvrey ; '. Payment Recd, $32.08 Over/Under r $3,464.64 Signature NOTICE: Pursuant to Government Code Sectlon'66020(d)(1);ahis wi serve to notify you that the 9"ay;approval period, in which you may, protest the fees or other payment identified above will begin,to,run from'.the date on which'.the buildirig or installation',permit for_,this,project is, issued, or from the date on which those amounts are,paid to the District(s) or to another public entity authorized to'collect them ori the District('s) behalf, whichever is earlier. NOTICE: -This Document NOT. VALID if -Duplicated' Embossed Original - Building, Department/Applicant Copy - Applicant/Receipt Copy, Accounting R DISTRICT - PLANNING REVIEW. FORM .This form is to be .used by _CDDstaffi for review of single family .d_wellings- in the RC (Cove Residential District;'per. Section `9:50:090 of.. the; Zoning Code. I.ts purpose is- to determine: 1) .- that. the proposed housing design,does not duplicate the same architectural style of any house within 200 feet of the rapplicant,: and/.or 2) if,, there is2`9 :need for the. applicant to file for Master Design Guidelines If the, applicant does need tb.lile. a IVlaster:Design Guideline, please transmit this information •to'.the Building: and :Safety :Department as part of your correction list. Please attach. additional. explanatron�s as necessary. APPLICANT: r"C•Yl- O:: SITE ADDRESS: APN -773. - o29 G -CASE NO... 9o2d . LEGAL: LOT BLOCK UNIT S:C.@V.L.Q. CHECK AND APPROVED.BY: DATE: Inform the assigned Building, plan checker upon your,assignin.ent to this case. The CDD Executive Secretary maintains a .log .booto.trck.aplpcations and assign case numbers. REQUIRED ITEM Y ';N COMMENT/CORRECTION Verify legal -.and APN..information Consistent with MDG -on file' (as applicable) :MDG filing required (5jilings since 9/3/98) , Architectural variety within= `200 feet of the surrounding area:-. Architectural de.sign:features Other Requirements: Approved Date Reso D.Planning Commission:. . Community-Dev: Dept: Initia'ls'.'{. ase o:. uhibit b With Conditions j V _ .. .._-___ ... .. �.__ ..��. _.-.._,_..� ......�.._-�..��.. �..,�-�.:...... ..� ..^ ...^.... •.a � _ _�. ...+.w•.�.......+ ..u.--+-.r.�.=mow......... Sladden : E" ineerin _ 0004-14 9 6782 Stanton Ave., Suite A, Buena Park, ,CA.90621 (714) 523=0952 Fax --(714) 523-1369. :. . :. •39.-725 Garand Ln., Suite G, Palm Desert, CA 92211. ..-(760)-772-3893 Fax:(760)' 7727"3895. Date. 3 6 Job No. FIELD MEMO...' Project Name: 14 �� i� Client;Site Address 7 - Job Job Phone .. Work Done; Test Summary / Footings Inspected Test No. Loc atio — j� Elev. Dry Density Moist % %,Relative- Compaction• Ref. Max ` ' pcf . Moist AV + F �3 r Comments C � i 41- C r X (r o ui •��rla Field Tech. `w `Supe% or Agen 24* hour.notice requested to schedule Field Technician. Thank you. for the opportunity to be of service. Certifica to of Odcypancy r - OF 9 Y Building & Safety DepartMeat This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the Wine of issuance, this structure was_ in compliance .with the is provisions of the Building Code and the various ordinances of the City regulating building -construction. and/or use. r p E a �r 1 ;BUILDING ADDRESS':.,52=655 AVENIDA RUBIO Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0401-105 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC g I Owner of Building: JAMES BELKNAP Address: P.O. BOX 297 City, ST, ZIP: PALM DESERT, CA 92261 By: STEVE TRAXEL ! del Date: 6-21-2004 Building Official f j% i POST IN A CONSPICUOUS PLACE 1; i Ua