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0104-144 (SFD)LICENSED CONTRACTOR 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 -my License is in full force and effect. License # Lic. Class Exp. Date Date -5r Signature of Contractor f "� �^"'j 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: Gamer Policy No. MKMPT (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 pro ons arm Date:'- ^ r .. t" Applicant— War pplicant -- x, Warning: Failure to secure Workers' Comp= 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 i . spection purposes. ._Signature (Owner/Agent)- Date BUILDING PERMIT : PERMIT# :' ' DATE / VALUATION LOT TRACT , S"ow 0 20 JOB SITE ADDRESS APN 1' r r' +� ifs q'T��p�A a AA �g�� <� 3-821 i�,Gde..u"`id.fJdv..l" AlY{�6i:{.Fu'.¢. i�•i`g^QK.tA':ti,. OWNER CONTRACTOR / DESIGNER / EN (NEER JAMS, 8 C. IW.0 AP, ars.. JANT, 5 C. HWCNc 4j_), JP 73.300 T4JDD ..1 t1=: LAIM 73-3GO 1•?CX.MMIL, CX 1.l�M, "• 1pXA 'DF f.rr Qk 92261 PALNI DT�y i",E`R CA 92261, (760)837.156£ C':ZIN 296 USE OF PERMIT ffWQLE FANMY .;TrD-PEi! MIT DORS WO`P YNC.'LU DE OW(M. W.A.I,%fPOOLr`3PA O.R A. PROAC H TRACT CrJ1cdSTRUCiiON 11465.00 SF PORCHMA` IO ".00 SP' QARAQZ 418160 9F - ESI'1;TMAfl.'.Q`ED COST CYV COINSM19CWOR 99,4U0.10 FXkMr,FFEX i ifk 34f CC' C^ONST':RUCT'10T1 FXZ 101.000-1418.000 $639.50 PIAN Cri3EZ11C Mtn 1CJ9-�:tivEl-�i3 31.3 x'33:63 FIM DEPOSIT 101.000.439.318 -5250,00 t41.WHANICJ'U.}yEE 101-000-421-000 $60.00 ` F;l..iWTRTCAL"M 101-000-420-000 $ 1$<14 k)W%J'.,MBIN Q PEE 101-000-419-000 1136.06 6 WWI MOTION 1+22 • REBID W1 -000-17A]1-000 S9.9s Ok ADINO FZZ 101-000-423-006 $70.00 DEVEWIFER. IMPACT i' FEE 3t,gt!?'att0 pAr :llur PLAN 101-000-441-345 $1€ftt 00 ` .• I ..'r0 .-AL i. 0114 tR{.7biIOA`d AND 1`].of"' MdE/4.X $3,5:1z.62 . :I..1_153 x:R&PAM FEEZ X rMffrFERS DUE NOW FPFA 2 0 2001 ii "V250.00 CITY OF LA QUINTA RECEIPT FINAN P6EEPif BY DATE FINALED INSPECTOR t INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs cj• S Underground Ducts r Forms & Footings a!-�� A - Ducts i Slab Grade - Return Air f Steel Combustion AirRooI f �' 20� O � Exhaust Fans O.K. to Wrap ( S% Framing�� Compressor I Insulation_((•. p 1 5 Vents [ Fireplace P.L. Grills i. Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines I Party Wall Firewall [ Exterior Lath Drywall - Int. Lath FinalFinal 1�po POOLS -SPAS r BLOCKWALL APROVALS steel I k Set Backs Electric Bond ' Footings Main Drain I I Bond Beam Approval to Cover Equipment Location 4 1 Underground Electric [ I Underground Plbg. Test Final Gas Piping { PLUMBING APPROVALS Gas Test Electric Final Waste Lines % d_ �/ �a Heater Final Water Piping Plumbing Final I Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping [ Gas Test m I S7 [ Appliances j Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole i Underground Conduit t Rough Wiring i Low Voltage Wiring Fixtures L Main Service Sub Panels Exterior Receptacles I G.F.I. 1 Smoke Detectors 1 Temp. Use of Power 1M�� s7 Final Utility Notice (Perm) :i Building Address Owner I Mailing Address T4tyl 4 4 " P.O. BOX 1504 78-495 CALLE TAMPICO ?ASU i tzCM,1( UINTA, CALIFORNIA 92253 Zip _ ITel. ip I ?Cgd6 -0-111.7 8, Classif. # �� Arch., Engr., Designer I Tel. Ellty Zip State �VA � I. _ 11®�,n -� �d Lic. # �/1�,�,? i 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 of not more than five hundred dollars (8500). I: 1, as owner of the property, or my employees with wages astheir 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 or completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 111, 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 or 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 ] 1 am exempt under Sec. B. 8 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 C pp, ,tip surance, or a certifie cop thereof. Sec. 3800, abor Code.) Policy No. � Company AAC4& '� fl 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 (5100) 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. l Date Owner NOTICE TO APPLICANT: If, alter 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 1hereby 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 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 property for inspection purposes. Signature of aeplicant Date Mailing Address City, State, Zip APPLICATION ONLY �5 ILDING: TYPE'CONST. OCC. GRP. '. Number % 2�— /& e) — C Tal Description LA !ff a5 , U-�4 0.3e, Description 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 �i8rfmifA R Validated by: �pn ry 1 � v Validation: 1,V1 R aMARA" all WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Sq. Size Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. r^� Plan Chk. Bal. W ' Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure l 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 �i8rfmifA R Validated by: �pn ry 1 � v Validation: 1,V1 R aMARA" all WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION .. Desert<'Sa' dds Unified Schoot'District 47-950 Dune Palms<.Road Notice:` La Qamta, CA 92253 Document Cannot Be Duplicated 760 771'8515 f ` CERTIFICATE�OF-COWLIANCE Date 4/20/01 APN# 774-162-005 No. 21912 Jurisdiction La ,, utnta Owner NameJames C. Belknap Permit # No. 53-820 Street Avenida.Ramirez R « City La Quinta zip 92253 ^ .. Tract # Lot.# ; S4uare,Footage Type of Development Single Family. Residence Comments Log # Study Area 1665 No. of Units 1 At the present time, the 'Desert Sands Unified' School Distnct ;doe's~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 paymg'':`s`chool fees at this tiriie due' to the following reason: EXEMPTION NOT APPLICABLE 41 This certifies that school facilityfees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,665 or V1,41125. the'propertyasted 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/ Guaranty�Fedefal Bank - James C,. -,.Belknap Telephone'�0 772-1345 Naine on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Paula Ruiz Payment ,Received $3,413.25 - 7i Check No. 1769664' Signature A .. NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to. notify you that;the„90-day:approva6penod m which you may protest the fees or other payment identified above will begin to run from the date on which the building or installation pemnit,for this project is sssried or on Which they are paid to the'District(s) of to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application"form to district copy for all waivers. Embossed Original -'Building Dept./Applicant Copy - Apphcant/Receipf Copy - Accounting 4 U k/ Li/Ul IZ:V7 FAA -909 890 3810 FIDELITY TITL.F;, Moxw4fro NOW= By COPY, 'a bwMM0-wft*Cww AND WMIN XZC4RDW MAIL To -0 Janos C. Baum , Jr., T"Utee ; 32 Cami Arroyo Place Palm DewM CA 92260 original. FRA-Wi� IL.J Abon'Ibm Low far Rawftra Up 0ajy A.P.N.: 774-1 Order No 330=4, Eicrow No.: 2-32W - - =A5 GRANT DEED 5- 3 =a LM 15munfam MANTIOR(s)l WI -020) THAT 0 - T D(XUbffJffARY TRANSFER TAX LS: UoUry I -Y S#2.5() on, fim Vistas of f. 010-Igmed. "or %II value Ime;W-4i at me pt qatr. FOR A VALUABLE CONSMERA710N, Receipt of which is bzraby &cknow-led-uad JaUffin F. PWagdd. Trwtu of Ue.Sri vor'sl1ruxt tvmd Fdz$ddF@mAy Trat. UA doled BW 31, 1978 baft GRANT(S) to James C. BOW", Jr., Trust= Of The JaWw C. A*Ibmap Sepmute *I'rmt, dated May 5, IM the Mo%ing described pwPam w the Ciry of La (btinta. Coumy-of Riverside State or (:&itbrnja, IAts is, 0 one�28 in 31MCIx—mlof Tract Santa -.f wnellts at Vale IA -QUiMa,, UUA-N0. 22, in the City of La. Qgbft, CA" or w per aw* reco0did In' P* 24 of'. Mals.. Records of XjvWdft C600y, Cdffmvb. The &wvivWs Tnut under Feingold Family Trwst, UA dated May 31, 19*18 L49 IMM P. Fainguld.-Tnme Dommm Date. 29, MW E. EMS OP.04LAICMIA COUN17-OP - . 9&02Lj^ 1 L I ZL;.L. P*Wom* logo as Iftwou"W to Iasi that I f '-j- U"ft be -dw" ft pulwaaaw, e3 wrrmm my lmd, ow offww sew. TW wr4 for Of1j"Ll ADOUW SCOL " Tax Stamexft to: SAME AS ABOVE or AddreAs Noted Mow r• al RC DISTRICT - P.LANNINGAEVIEW TORM - This form is to be used -by CDD staff for. review of single family dwellings in the RC (Cove Residential) District, in order to determine the applicability of comp, or need to re, uire:.the filincof Master Z . o! Design Guidelines by the applicant:- It slill be fransmitted to the Building,.and gwF correction list. Please attach:additional explanations as -necessary. N ..< ASSIGNED TO CCS i APPLICANT Be lkna P (INITIALS) SITE ADDRESS 53-82a Avenida Ramirez. APN 774 162 - 005 BINNO:: CASE --.NO,: 2001-426 ' 2 0' 2>�3 6 '�• LEGAL: LOT , BLOCK UNIT S.C.@V.L.Q. CHECKED BY: Wa11-y, Alesbit, . DATE: Inform the assigned Building ,plan checker upon your,.assignrnent .0. this case. The CDD Executive Secretary maintains a:log book fo track applications: an, °assign case numbers. REQUIRED ITEM " Y. N `.,. COMMENT/CORRECTION Compatibility Review w, a Case. logged and number assigned Verify legal and APN information r a Consistent, with MDG or f le. (as.applicable /"�i9 . MDG filing required.,(5 filings since 9/3/98) ' Consistency with street%surrounditig area.: .. Colors Materials Architecture" D1�C " y Other Requirements: O Planning Cdrn0d66tote O City Council'soft �Commun 6WIDOL Initialn ,z `Case Alo.,. Exhibit r O With Corstditiotl�Ai L Certificate of Occupancy 4ci o t f L aQuin to k.�MD 6mild".., an S.afet De artment This Certificate issued pursuant to ahe require ments. Secti6ni, 109, of the' Uniform'.Bu#ding Code, certifying that; .at: the': time of issuance; ` this :structure.' was in comp/lance .with.1he..various ordina .Hees of the City regu/ating•building construction or use For the following: BUILDING ADDRESS: 53-820::-AV.ENIDA"`RAMIREZ Use Classification: SFD: Bldg. Permit No.: 0104=144 Occupancy Group R 3: - Type of Construction: --VN Land Use Zone: RC- Owner COwner of Building: JAMES C. BELKNAP, JR. Address: .7.3=3.00 FIDDLENECK LANE _ City: PALM DESERT;" CA 9226 1' '.. By: STEVE TRAXEL Building Official µ . Date: 09-04-01 POST IN A CONSPICUOUS PLACE CARLOS ELIAS REGISTERED CIVIL ENGINEER 38825 Charlesworth Drive Cathedral City, California 92234 Telephone (760) 328-7271 March 7, 2001 City of La Quinta Department of Building & Safety 78495 Calle Tampico La Quinta, Calif. 92253 Gentlemen: This letter concerns the residence to be constructed at 53820 Avenida Ramirez, La Quinta, California. The Simpson strong -walls as noted on the framing and foundation plan are adequate for resisting the wind and seismic lateral loads that may be imposed on the front wall of the garage. Very truly yours, Cam 1 Carlos Elias CE: j