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0301-182 (SFD)LICENSED CONTRACTOR'DECLARATION I_Kdeeby 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 r70;1t�31 -Du36 CIA.2 1;1 � x6:4Dlil ,.Date - -' ' �--Signature of Contractor I�fis 1 ' 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 theproperty, or my employees with wages as their sole compensation, will do the work, and the structure isnot 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). () lam 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: CarrierTa�,.1 Policy No. kg33 (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,) shall forthwith comply with those prdyisions. „ ,Date-)• " I , Applicant J —', Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, intere'stand attorney's fees. IMPORTANT Application is hereby made to the Director of Building and S.Ifefy for a permit subject to the conditions and restrictions set forth ort ,his . application. y4 1. Each person upon whose behalf this application is made & each persofn at- whose request and for whose benefit work is performed under or pursuant::to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2: Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City,. and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon. the above-mentioned property for inspection purposes. r Signature (Owner/Agent) f T Date BUILDING PERMIT PERMIT# DATE VALUATION ��. LOT - f TRACT --K; K 20.1; / JOB SITE .ADDRESS - �J`Jt . sY/�;,�L.C�.�L) A%fA'%E I C APN 774•W+027 OWNyyEpARµy��1 CONTRACTOR /}DESIGNER /�E�N1N�[EEERg7� ( Y' p .,+C'►4�I.eit: 2?AC4L�d"J,�'` J•!'dAYA.7��2 �t. F)5:.�:.3!sl L,A"+i' � d.S.F... P -0.:l ox. ZT? 73-3 00 M1X INII'CK LANE T'AUd Z!°EERT ",A 92'261 P.t?,LM1.1), C, 7RT C.P. 92261 CItS0)7-9, 5372. ms USE OF PERMIT SYOa 16M SIS. PERMIT DOES NOT INICLU DE 81-DCiC 'Vef'.AIA, P002, Ca, �I°dk`� RWAY• APPROACH, 1W b d.5T. V:.' Alv7 >sNED PER 99`17 ;,I a'X1+aSli M ADMIM, CODE §304.5 FOR 'WORK. Bi'GIn4 W/O BUIi,'i.3IN G PB12AA T. TRACT CONSTRUCTION O i` �ORCi3t'Pa3.. ld— l Ill. Oil Sig fi>d4x`i$jRtJ�.i7`Iii 3Tx:d )(?i.,000-419.000 PLS CHltkX FEE $394.45 Fry;DPWIT 4260.00 '92C.KAN'IC.e+U.IPEE 101-000-4,21-000 $50.00 t:� EE 10 1 0�ylte PLU!MOiNG FZS 101.000 -4„19 -0 -DO $124.00 5`I*D;tON0 Mv`HUV TU - USID 10,74 O ADti OMY, 101w0G"23-000 $)5.fa2r DEVELOPER 11 -AP A,U f KY, 9:x,403.40 PR PLOW 101-000-441-341 '.� P 9 GI' ? ` $4,6`12.25�? O PMM-P AM'S 7731 42.50,00 Damn y r s D t Now t4,z W_2_52` y CITY OF LA QUINTA e>iF FINANCE DEPT. H �•' RECEIPT DATE5 BY DAT FINA,LEP INSP INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs IT " C Q3 Underground Ducts Forms & Footings — p 3 Ducts Slab Grade — GG Retum Air Steel Combustion Air Roof Deck Q3 _ Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation 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 _ �� (�3� 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 Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines 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 _ Q3 A—ppliances Final COMMENTS: Final _ Utility Notice (Gas) /6 ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Leser Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) �� L� s Building Address Owner Mailing Address ty ontrac Address 'Fe09ClG11l `( eek. I -t `t -1 LX " P.O. BOX 1504 f78-495 CALLE TAMPICO i — J1 ?Tl h h ifLA OUINTA, CALIFORNIA 92253 p & Classif. I Lic. # Arch., Engr., Designer . 1 11 I Tel. City (Zip (State Lic. N 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 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 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 ($500). I -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 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. IL 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 I 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.) I'! 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, Labor Code.) Policy No. Company �r 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 i1 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, 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 I hereby 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 it 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 applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT ,01 ir(050191� APPLICATION ONLY BUILDING: TYPE'CONST._OCC. A.P. Number V q—n Legal Description Project Description 4d& 12 GRP. Q— na 7- q S3 -5�0 ?92hn�c.h a3— S9. Ft./ Size l (Dnq No. No. Dw. Stories % Units New`- Add ❑ Alter O Repair O Demolition ❑ cat CM-) (LG f Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. L Side Street SetbacF fro nQj Side Setback from,P oreI FINAL DATE Issued by:— Validated by: Validation: YELLOW = APPLICANT PINK = FIFNANCE 4 CERTIFICATE OF COMPLIANCE ��Ft�se Desert Sands Unified School District, zq�eso 47950 Dune Palms Road r _ q Q BERMUDA DUNES r Date 2/21/03'' La Qdinta CA 92253 (n RANCHO MIRAGE d f � INDIAN WELLS - ti PALM DESERT No. 24167 _ (760) 771-8515 y ��,LAIN UI T Q o y Owner James"Belknap ' APN # 774-064-027, Y ' Address P.O. Box 297,Jurisdiction La Quinta CityPalm Desert. Zip 92261 Permit # 0301-182. Tract # BLK 205 Study Area ' Type Single Family Residence No: of Units Lot # No. Street S.F. Lot # No. Street S.F. , Unit 1' 5/6 53105 Avenida Navarro 1604 Unit 6 Unit 2 Unit 7 ` Unit 3 Unit 8', Unit 4 Unit 9 t - Unit 5 Unit 10 ` Comments Certs #24163 through 24167 used for CC #305788 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 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 propeity listed abave 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 - James Belknap Check No. 305788 Name on the check Telephone 760-902-7444 Funding Residential By Dr. Doris Wilson Superintendent Fee collected /exempte by Sharo GilvrBy $3,432.56 0.00 Payment Recd Over/Under Signature , G NOTICE: Pursuant to Government Code Section 66020(d)(1), this ill7build�ing y you that the 90 -day approval period it which you may protest the fees or other payment identified above will begin to run from the date on ior installationpermit for this project is ftsued, 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.Y.N.: 774-064-027-9 TRA !#: Space Above This Line for Recordec-'s Use Only Order No.: 33020228 Escrow. No.: 2-33971 GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $27.50 [ j ] computed on full value Of p roperty conveyed, or [ unincorporated area; [ X 1 City of La Quinta , and FOR A VALUABLE. CONSIDERATION, Receipt of which is hereby acknowledged, Joseph L. Waisman, Trustee of the WAISMAN FAMILY TRUST, dated September 13, 1976. 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 Quints, County of Riverside State of California: Lot 5 and 6 in Block 205 Santa Carmelita at Vale La Quinta, in the City of La Quinta, County of Riverside, as per map recorded in Book 19, Page(s) 38, in the Office of the County Recorder of said County. - Joseph L. Waisman, Trustee of the WAISMAN FAMILY TRUST, dated September 13, 1976. By: seph L. Wai man, Trustee Document Date: July 26,'2001 STATE OF CALIFORNIA )SS COUNTY OF_/2 On l.is7lh 9" l Zl?U( before me.1141teu /7 �i✓.� - N�'r7l Q personally appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(;) -whose name(sj is/awsutscribed to the• within instrument _ and acknowledged to me that he/stye Uy executed the same in his/keg/their authorized capacity (49&) -and that by his/ken4hat- signatures;—on the instrument the persons} or the entity upon behalf of which the persons) acted, executed the instrument. WITNESS my hand and official seal. Si nature ) 'J Sig •1Cl�I/��iUv' '�7' 11V"� MATTHEW J. BREWER NOTARY PUBLIC- CALIFORNIA HCOMMISSION# 12977 ORANGE COUNTY My Comm. Exp. February 2, 20+5 r Mail Tax Statements to: SAME AS ABOVE or Address Noted Below