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0208-357 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7,000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License'# tic. Class Exp. Date y,. 205 101 BC36C42TR 11/:5012( 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; 704.4, Business & Professionals Code). ( ) I, as owner of the property, am exclusively confr9c—tinir 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 1. �, . 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. (e 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 STAT1a ej1L1)J J Policy No. 1576785 x (This section need not be completed if the permit valuation is for $1'00.00 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: '' Applicant f' 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 cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. +Signature (Owner/Agent) Date #, --BUILDING PERMIT PERMT# DATE VALUATION LOT TRACT r/ 7,394.90 22 n�t1e JOB SITE^ ADDRESS APN �i �1'�^��r•°ES OWNEAR CONTRACTOR 1NEERykq ly �y ^97 yy�q 1/EN P.O. DC)`�C:I.In PALMDE��?XXV CA '.92261 PALIN i?ESM CA, 5+2-261 (760YY77-MZ ("B7�S4 2905 USE OF PERMIT , WGUs kAW.£ Y 1tiW,► I.MG 1604 S,47. dYD P°fC4tiMIST %OMINOT 114Cl UDE BLC.Ft; K tiar+iV, POOL OR, PLAN S�:'�� 9,I)i.. R .FOR. NiUL �•IINIF, - Dd5..1V.�� ,7w'I/'�u.Y/yApi.1��1P�Rg�(.��.►�b•�'��:H.. i51%Q�+��7M��..E.r.� ISNUAN CE VI'Kl.C1,LL'lA:i}�1,AW 1 PI4 iT�A.CT :oCS*J3"!'RUCTION 104M Si' r 4 PORCHWA T IO ' 117.00 SY rttii3.A.avC.`.ARP,0RT VW CCaW;�Tk2.tJG'1''S4�7d �i?'� 1t�i�4�C!t'k�1Ca•t)t�� �6�0.�t1 P4" CHECK i+'E1y FUE DEPOSIT 1011.-000-439-318 �230:R6 Nf�.°1}16.N1C'�laY., .q'f�dJ T r7 t ••tiC341-�� 1 �iMJa1 �'i�,t"Pfi ELFICTPJCAL FEE l C1 i-C10t1��47 C��CiCits � I l,e, �b PI.'tJ1UfBINO FEE i C?2-t1s)�J �11�=CeG �136.0tb ITFRONG Mo NION RE MIND 101-:000-241-000 DRAIX'NO M, 101 ril�'VEWP11:R1M3sAWT li19 PRECISE. MAN �;flx -f3t1J �+'li- �Fi� �1f3t�.f10 - 9 M3 :MAL C1t +9=ilt` 1'10 AND :iR�i..±`Y CTILM '�$'3,619,62 f l;.l; M '11RE PAID F'ERS 4250.00 'moiAL I'Mviry III.= DUE ff0w lop / RECEIPT CITY OF,WUINT�• U BY `'.• DATEFINgL INSPECTOR r FINAM INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings - Ducts Slab Grade (,L Return Air Steel Combustion Air Roof Deck - (J- Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation ZZ - r%. �_� . Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final - d POOLS -SPAS BLOCKWALL APPROVALS 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 Q_� Encapsulation Gas Piping Gas Appliancess Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole 01- 2- 0 Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power tAr,� Final Utility Notice (Perm) LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provision4 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 Exp. Date 205031 B C36 C42 HI 11/30/2( 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. /U44, Business & Professlunals Gude). ( ) 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 FUND Policy No. 1576785 (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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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. L 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 cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date sGiieo� BUILDING PERMIT PERMI0 0208-357 DATE VALUATION $97,39490 LOT 22 TRACT BLK 231 JOB SITE ADDRESS 53`540 AVENIDA FAAI= APN 774-122-003 OWNER CONTRACTOR / DESIGNER / EN INEER JAMES BELKNAP JAMES C. BELKNAP, JR. P.O. BOX 297 73-300 FIDDLEXECK LANE PALM DESERT CA 92261 PALM DESERT CA 92261 (760)777-9572 CBL4 2905 USI UY VeHMI•I' MNGI E FAMILY DVIE LING 1604 S.F. SFD PERMIT DOES NOT INCLUDE BLOCK WALL, POOL OR DRIVEWAY APPROACH. 75% REDUCED PLAN CHECK FEE FOR MULTIPLE ISSUANCE OF SAME PLAN TYPE TRACT CONSTRUCTION -1,604,003F C� glce PORCH/PATIO 117.00 SF GARAGE/CARPORT 446.00 SF ES`rR4ATED COST OF CONSTRUCTION 97,39490 PIAT FEE SUI D4"Y CONSTRUCTION FEE 101-000-418-000 5630.50 PLAN CHECK FEE 101-000-439-318 $136.82 FEE DEPOSIT 101.000-439.318 4250.00 MECHANICAL FEE 101-000-421-000 $73.00 ELECTRICAL FEE 101-000-420-000 S113.56 PLUMBINQ FEE 101-000-419-000 $136.00 STRONG MOTION FEE - RESID 101-000-241-000 $9.74 ORADINO FEE 101-000-423-000 $15.00 DEVELOPER IMPACT FEE $2,405.00 PRECISE PLAN 101-000-441-345 $100.00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,619.62 LESS PRE -PAID FEES -$250.00 ,TOTAL PERWr FEES DUE NOW $3,369.62 RECEIPT DATE BY DATE FINALED INSPECTOR CERTIFICATE OF COMPLIANCE Desert Sands Unified School District zo�cao 47950 Dune Palms Road ¢ BERMUDA DUNES r La Quints CA 92253 � RANCHO MIRAGE d Date 9/18/02 , INDIAN WELLS ti No. 23631 (760) 771-8515 `�,� PALM DESERT ' ��INDIO 1 J5 O Y Owner James Belknap- APN # - 774-12.2-003 Address Jurisdiction La Quinta City Palm Desert Zip 92260 Permit # Tract # Study Area Type Single Family Residence No. of Units 1 ' Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 53540 Avenida Ramirez 1604 Unit 6 Unit 2 Unit 3 Unit 4 Unit 5 Comments Unit 7 Unit 8 Unit 9 Unit 10 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiosMalkways, 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: III EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to 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 La Jolla Bank - Jim Belknap Check No. 304854 Name on the check Telephone 760/8371-1566 Funding Residential By Dr. Doris -Wilson Superintendent Fee collected /exempted by Monica Guillen $3,432.56 $o.oc Payment Recd 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 on 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 Department/Applicant Copy- Applicant/Receipt Copy -Accounting RECORDING REQUESTED By AND WHEN. RECORDED MAIL TO: JAMES BELKNAP SEPARATE TRUST 32 Camino Arroyo Place Palm Desert,.Ca 92260 A.P.N.: 774-122-003-6 TRA #: Space Above This Line for Recorder's Use Only Order No.: 33052482 Escrow No.: 2-36885 GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $44.00 X ] - computed on full value of property conveyed, or ] computed on full value less value of liens or encumbrances remaining at time of sale, ] unincorporated area; [ X ] City of La Ouinta , and FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, Mary Lea Toher, Trustee of the MARY LEA TOHER FAMILY TRUST, dated August 29, 2001. hereby GRANT(S) to James C. Belknap, Jr. Trustee of the JAMES BELKNAP SEPARATE TRUST, dated May 5, 1992. the following described property in the City of La Quinta, County of Riverside State of California; Lot 22 in Block 231 of Santa Carmelita at La Quinta, Unit No. 32, in the City of La Quinta, County of Riverside, as per map recorded in Book 20, Page(s) 24, in the Office of the County Recorder of said County. Mary Lea Toher, Trustee of the MARY LEA TOHER FAMILY TRUST, dated August 29; 2001. By y L\4�L1�1C Mary Lea 'j�er, Trustee Document Date: July 10, 2002 STATE OF CALIFORNIA )SS COUNTY OF 0 ra-A) ) On__3 q — Q before me,o ke—r — L . Woo personally appeared -(er proved tWne on the basis of satisfactory evidence) to be the person(s) whose name(* is/am subscribed to the within instrument and acknowledged to me that ke/she/gwy executed the same in+Wher/their authorized capacity(ies) and that by-Itis/her/thrjr signature(4 on the instrument the person(o or the entity upon behalf of which the person($ acted, executed the instrument. WITNESS my hand and official seal. Signatur This area for official notarial seal. ROBERT L WOO COMM. #12SU71 M Notary Public-Callfomia tp Lao— ORANGE COUNTY MY Comm. EXP. Feb. 13, 2004Mail Tax Statements to:SAME AS ABOV -•--•i 77 C. laidderi En"A gi eering 6782 Stanton Ave., Suite A,BuenaPark, CA 90621 (71 523-0962 Fa-& (714)5*23'13E9 1:39-725 Garand Ln., Suite G,"PalrF Desert, CA 92211 1(760) 772-3893 Fax (760),772-3E95 Date Job Vo. '97-7-- ZZ 91 5 4 FIELD MEMO - Project Name I&Y, Iq n^ Client: V Site Addres's Syf-,4499 _452 - Job Phone"' w6rkb6he C OV -V C4 44 1z 4r. • Test Summary / Footings Inspected Test No. tocation Elev. Dry Moist* % Relitire -Ref.'Max Moist Density % Compaction % 7­� +\ J Comments V J eld Tech. ___1% 24 hour notice requested to schedule Field Technician., Thank you for the opportunity to be of service. WaN Certificate of.Qccupancy. City of La Quintal Building and Safety Department This Certificate issued pursuant- to the requirements. of Section 109 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: BUILDING ADDRESS: 53-540 AVENIDA RAM.IREZ Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0208-357 Occupancy Group: R3 Type of Construction: VN Land Use Zone: RM - Owner of Building: JAMES BELKNAP Address: P.O. BOX 297 City: PALM DESERT, CA 92261 By: KIRK KIRKLAND dot _ Date:, JANUARY 29,-2003 Building Official ' POST IN A CONSPICUOUS PLACE