0012-196 (SFD)�''► 7 ki LICENSED CONTRACT OR,DECLARATION
hei;eby affirm under penalty of perjury that I'.am licensed under provisions of
�YChapter 9 (commencing with Sectiori'7000) of Division 3 of the Business and l
' *Profes§ionals Code, and my.License'is in full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor
/,- .2
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).
O 1 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:
Cartier . Policy No.
(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
§.abject to the workers' compensation provisions of Section 3700 of the Labor
,'./Code,'l 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.
.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 cancellat'-)n.
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)nspectio//n', purposes.
Signature (Owner/Agent)(/ Date f
_PERMIT# �•� !"'i.`yy. �P _
Mt
. .BUILDINGP.ERMIT; .`- H „�
'+;VALUATION ~�
\TRACT44tyr,� lr
DATE, Vit._»� LOT y��f�it5
1 t ,»::,-33L1C2-iF (1W
JOB SITE
APN
ADDRESS
, r T t
�(�d '�•
� �r�{0�� aq pyp 9� w ►g/�}5t f�� /
o7+n�YYiY'41' 1.`A 1�a�nLr�Y.B'ft. �ladl�.Ef[I'' 6V.'a.7.'�Ce
p @. C �' �D-
d ��"A.�l.♦r^:.iP P �
OWNER
CONTRACTOR/ EN INEER f `
JKUES C:. ,P,MCNAI , JR.
e(AAr3O C. 1.i °1'NAP.'.J7;t
73.3001*313:r .LI CK LAfft.
PALTADES.M. C'.A. 92261
PA:I M i31 a `1' CA 92,261 •-n �' , - 't
6L93 '15E�i C:f 290a
.d"
USE OF PERMIT
- ,r
+�yy,�p(p � q ��!`Q'� '{,p �gpy�� � •yy�7/y
N.L�'6\JLb° �+.i'fDCLI1.iZ � V9 �•.�..f •FNks-
r 7• .• S'a.
SVI) VV/VFT.A 1Ii:FD nUif;. T HOUSE - I;'Li'.MIT D09S NOT INCLUDE 'f,8WCK
1XIAL.1, POOL, OR DRIVEWAY APPROACH w
T
IT.
TRACT CONSTRUCTION 1.743.00 n
PORC:HIPAX10 72.00 SP
G ARAOFXARPOR (SID 31290,80
' r,
51°x1'. WOOD PENCE 0.00 111P
,
RM16QA'1„D (70&'1i' OF C✓f?Nls'. i1G (, N
1.04M420
CONSTWUCTION FE -13 101-1JN-418-000 0637.00
PW.4 Cimer, vu 101-000.439-31B `6KA.z 3
F'is"11..�yO,�1*.�P�,iy�iSITT 1g01-t�00-439.3•x/18
p���q
'Ail' M. �.K,l!4A.1'31C.A.k, FRE 101-000-421-000 !�J�. ?J
, YI1 4l: ii j`{ •
1yJAC'T1U0di,.L FPX, 101-t9W-4243*000 $10.14
1aI.L'A&BI'1+O IMPI- ; 101-000-41.9-000 V154.7 5
•� � {
BTRONG MOTION FER - R231.0 10 1 -000-VI 1 -000 $10,48
' 't
d iRADTha FEE 101-000-423-000 $20.00
`: t
Dks9TriGo."1..&BIER IMPACT Fig $1,907.00
r •,,
PRI%C)S'H,PI.A1d 101-003-44.1-345
OLTA-WtAL CONS`1"itUC."flOK AM 1 AN (51Eir3::
$°3,636.60
1.100
�T
!
RECEIPT
I DATBY
DAFT AeAl Z
INSPECTOR
t
INSPECTION .RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings LL ,p)
�,./ .
Underground Ducts
Ducts
Slab Grade
_
/�-�i�
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
3—Z Z.p
!(3. C L
4
Exhaust Fans
F.A.U.
Framing
STj'
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
y Drywall - Int. Lath!r
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
FinalI
Gas Piping
PLUMBING APPROVALS
Gas Test
I Electric Final
Waste LinesHeater
/ _ �(
s
Final
Water Piping
�(
i Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
-
Pool Cover
Sewer Connection��.
of
��.
Encapsulation
Gas Piping
Gas Test
..'
Appliances
Final b,
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
r�. p L
1
-r
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fb ures
i Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
r
Final _
Utility Notice (Perm)
0 s7
elor- 6"-L. 0/ 5-/
,Z`
Building
Mailing -
Address .1
..i.y
rJ At A .c6 -A
State Lic.'
& Classif.
Arch., Engr.,
Designer
-
Lic. #
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. `^OCC. RP.
A.P. Number ��Lf•J J"(�/`-��1 r��� �j
�V( / C�- Legal Description t1 �/�--✓ ' A !' ' -�
Sta
Gt1L��. r 1 r I Z2. -G V ( Lic.
/ ic.
- LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Droyisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Pro"1.0ivsions Code, and my license is In full force and
effect
SIGNATURE ' ° `- - ! o DATE
.I OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 file 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 thealleged 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 ($500).
(11 I, as oner 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 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I1 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 contractors) licensed pursuant to the Contractor's License Law.)
C! I 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, Laggor Code.)
Policy Nol4C '7f 7.�'�: "Corripany -. Cri` (.e : , , , a.. --
f7 Copy is filed with the city. 0 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 ($100) valuation
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.
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
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 I have readthisapplication 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Project Description
r.
t1. X L Rpt .A+1 rb
Sq. Ft. ` Q No. / No. Dw.
Size +� 9C/ Stories �{..... Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I. r
Ke oj
Grading
Driveway Enc.
1
Infrastructure
TOTAL
REMARKS
V
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
Desert Sand9' , fi" We School llistr ct
47 95.0 Dune Palms Road
Notice: La QuWnta; CA .92253
Document -Cannot Be Duplicated' ; 760-771=8}}515
CERTIFICATE OFAAJMPLIANCE.
Date . 1/19/01,. , AP144 774-162-007
No. 21533 Jurisdiction La Quinti
OwnerNameJames C. Belknap;•Jr: Permit#00:12-196
No. 53460 `: Street Avenida Ramirez Log #
City La'Quinta zip', 9225`3 Study Area
Tract: # BLK23G,V22 Lot # 18 Square Footage 1748
Type of Development Seigle. Family Residence, No. of units 1
Comments *Received'a cashier's check ui the amount of $$3,3:86.60 aril $196:80 cash.
At the present time, the Desert Sands -
ands Unified School District does 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'sch6ol fees at this'time due to the following reason:.
EXEMPTION"NOT APPLICABLE.'
This certifies that school facility fees::
01/11/01 12:07 FAX 909 890 3610 F.IDfiL1Ty" TI'TLE
777
SLCAHDIIYG B13QUR8'1'i�`BY . , - . , z • , �
3A IPY; ®t rz�ooe�
AND WH M RWOI WED MAIL TO:
James C. Bellmali, Jr., Trustee
37 Camino Arroyo Place e1 bBeR 16d .11
Palm Desert, CA 92260 ori�it►e1.
�Ri11�K K. 19�i glow
x ' t
COr x,
. ' . sp 0 AZtOrE,ZbIS Lime far'Rwmdees Um Only
A.P.N.:,714-162:00'WW , TRA #. Oi6rNo 3300?�35 Ekrow No.: 2-322
3
513 86� z g 3:-gam}
Gk-ANT-DEED
THE utvD&BSICiNBb'GRAPFL�OR(s) bBCLA=4 THAT DOCUMEMARY 7RMSFER TAXIS COWry 8250
]l compared on, full value of propprty:cou Ms ,or
imputed os fall valUe •of llests;or ;antes rtmo8iiti09of time of'satle,
vatncorposated arca; city of
FORA VALUABLE CONSIDERATION, Roceipt of which ns beueby aKicaowl ed;
J65an F. Fi�old, Tiurtee.of'�'he,Survitror's 7(�wtAmi Y+':: ®id;F Tr
M � a`.Ttt; UA dated kitty 31, 1978
hereby GRANTS? to James C. Baelimap, Jr., 7nuEse or, The.James C. Beiitns :
P tnW, dated May 5, 1992
the fviloarng described propeM in.the City of Lu Quin%. Coiuuy'of Riverside State of Califoinia;
LOU 18, 19 and,,?A in Block 236 ;of `pact Santa 0lita at We-La s Qtanta. Utut•No 22." —the:City of L4 Q�
County or Riverside, as per map rest dad In Book-20, Pgge. �24 of 'Map6, .Recichu .of 'Riverside Cauitty, California.
fi
The Snrvivorls Trust under Fei pldFamily Trust, UA dated May 31,'1978,:
BY:
F. Peas ld Trustee
Document Date: ghee 28.2000
SrA*= OP CAI�FMIA .RAU r
As
on
tCCN=HY apP�ed «k.. f`.ol d}, ..
peeved tnrtea onbua4 of �ifit:0ary evideou) to Dc t4a peaoa whose
and aeltaowledaed m ,ae t6et tte/iilialie)t nsesvoea the in hi,r
am aonmd (1 iad dot b� addvn btmament
1a/A sad>acrbed m
the pC"&*,dr the entity upon Bgjatf of WN6 dte:petsoA�isted; aiscn $ on the
ted>rtc'bmmutoe6t.
TVT1I m'>y bisd.8w;of boaitl3_ed.
s�--RA,
d�Y/
+' Lhiruci`foI offical notitiat1 saL
R06i3tf L SOitit9!iifNO �
t , Cotttt>t�On d 4194750
Y
�' � Pbttsy Pubnc� tCo9lCfttiO
'f,: Wbcurm+.e�iaslu�a4.am2
r
MAH TW&Rkt�s to_ SAAB `AS ABOVE .or -Address,NatodrBelaw
J
RC DISTRICT - PLANNING REVIEW FORM
This form is to be used by'CDD staff for reyiew of single faiiiily`dwellings in the RC (Cove Residential)
District, in order to determine the.applicabilityiof compatihllity issues. or peed to he
the filing of Master
Design Guidelines by the applicant. ..It, shall`be' trans r itfed to the:Building and Safety Department as your
correction list. Please attach additional explanations as necessary.
APPLICANT BEI KNAP
SITE ADDRESS
APN 774`, BIN NO.: CASE NO 2000-358
LEGAL: LOT BLOCK 31.2 UNIT S.C.@V.L.Q.
CHECKED BY: Fred : Baker ° DATE:...
Inform the assigned Building plan checker upon your Assignment -to this case. The CDD Executive
Secretary maintains a logbook to track applications.,. d assigri case numbers.:`
REQUIRED ITEM Y N COMMENYT/C.ORRECTION
Compatibility Review
Case logged and number assigned
Verify legal and APN information
Consistent with MDG on file (as:applicable BX M DEVELOP
MENT
MDG filing required (5 flings since 9/3/98) ' F NIB
Consistency with street/surrounding area:
Colors
Materials
/_.
Architecture
Other Requirements: AP OVE_ i P
11 MFNT DEPT
1i✓`�
'Y' ` ,ATE'
EX 181T
r '
nlJ� CAS V . ,,.,...._._.........._.
• F
C
ertificate of Occupancy
City -of L aQuin
Busld►-r�g .aid Sa,D",
fetylmt. ent��ti
This, Certificate hisued"'pursuant to the' requirements of Section 70.9 of the Uniform Building Code,
.certifying that, ;at,the time of. issuance, this, structure was.in compliance. with the .various -ordinances
of the,regulating bui/ding` constructionp -use. .For thel fol%wing-
BUILDING ADDRESS:. 53-860 A.VENIDA: RAMIREZ.
Use Classification: SFDBI'dg. Permit: No.: 0012-196
Occupancy: Group: R,3 ` Type of Construction: ,.VN Land Use Zone: AG
Owner" of Building: JAMES C. BELKNAP, JR: Address: 73-300 FIDDLENECK LANE
City: PALM DESERT, CA 92261
By: STEVE TRAXEL
Date: 06-04-01
Building Official
..B
POST IN A CONSPICUOUS PLACE
BEL\