06-0249 (BLCK)~P.O. BOX 1504
.78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4tvl 4 4 Q"
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/06
Owner:
DOUG/CECILIA BELKNAP
PO BOX 297
PALM DESERT, CA 92261
Contractor: D
BELKNAP, DOUGLAS W A'
P.O. BOX 297 JAIV 17
1006
PALM DESERT, CA 92261
(760)902-7444 CITYIpF
Lio. No.: 205031 CMRA..!!�QV1111Te
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
Application Number:
06-0OQ 0249^^"-
Property Address:
. 51040 AVENIDA VELASCO
APN:
773-065-026- - -
Application description:
WALL/FENCE
Property Zoning:
COVE RESIDENTIAL
Application valuation:
4375
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/06
Owner:
DOUG/CECILIA BELKNAP
PO BOX 297
PALM DESERT, CA 92261
Contractor: D
BELKNAP, DOUGLAS W A'
P.O. BOX 297 JAIV 17
1006
PALM DESERT, CA 92261
(760)902-7444 CITYIpF
Lio. No.: 205031 CMRA..!!�QV1111Te
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C36 C42 License No.: 205031
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_
issued.
Dat : i ==Contractor. �l
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1576785
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall fort with comply with those provisions.
that he or she 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).:
Date: (% — OA_,�plicant:---:-.--�._
(_ 1 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 and Professions Code: The
WARNING: FAILUREJT.O-SECURE-WORK£ S�COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. --
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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.
1 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 county to enter upon the above-mentioned property for ir)spection purposes.
LQPERMIT
Application Number . . . . . 06-00000249
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 72.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 4375
Expiration Date 7/16/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
------------ ---------------------------------------------------------------
Special Notes and Comments
175 LF 6' BLOCK WALL PER SFD PLANS &
ORCO STANDARD
Fee summary Charged Paid
Credited
Due-
----------------- ---------- ----------
Permit Fee Total 72.00
---- -----
.00
----------
.00
72.00
Plan Check Total 00
.00
.00
.00
Grand Total 72.00
.00
.00
7.2.00 %
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 $2.24 X 1,875 S.F. or $4,200.00 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 Wells Fargo - Doug Belknap
CERTIFICATE OF COMPLIANCE
rs
�-
Desert Sands Unified School District
AC
47950 Dune Palms Road
o
< BERMUDA DUNES r
Date 10/25/05
La Quinta, CA. 92253
Cr RANCHO MIRAGE
INDIAN WELLS
No. 2781 5
(760) 771-8515
d PALM DESERT
,� LAG IO �y
J�Q INDIO
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Owner D. Belknap
APN #
773-065-026
Address
Jurisdiction
La Quinta
City Zip
Permit #
Signature
Tract #
Study Area
Type Single Family Residence
No. of Units
1
Lot # No. Street
S.F. Lot # No.
Street S.F.
Unit 1 51040 Avenida Velasco
1875 Unit 6
Unit 2
Unit 7
Unit 3
Unit'8
Unit 4
Unit 9
Unit 5
Unit 10
Comments
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions -under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. 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 $2.24 X 1,875 S.F. or $4,200.00 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 Wells Fargo - Doug Belknap
Check No. 0737704892
Name on the check
Telephone
Funding Residential
By Dr. Doris Wilson
'i itClil L.
Superintendent
Fee collected /exempted by Sharon MCGllvrey
Payment Recd
`
. $4,200.00 &Fier/Uiaep
r;
Signature
' t -<-tail a5 tii'y
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 o
r 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. S.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy - Applicant/Receipt Copy -Accounting