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0012-023 (SFD)LICENSED CONTRACTOR DECLARATION. 14iereby'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' 205031 q42 /30/v D�fe X21-5-42 1 Signature of ContractoL- 4(D ; 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: Carrierk! Policy No. EXUM (This section need not be completed if the permit valuation is for $100.06.or less), AllI certify that in the performance of the work for which this permitis issued;I 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 , hall forthwith comply with rthose provisions Date - 5— - lAPPlicant s 11..�a' L14a ning: Failure to secure Workers' Compensation c9verage 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. 1 ,. 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 behalfthis 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,g & hold harmless the City of La Quinta, its officers, agents and employee917 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 abov�e4information is correct. hagree to comply with all City, and State laws relating -Ac, the building construction, and hereby "authorize representatives of this City- to enter upon the above-mentioned property for inspection purposes: ' .� : 1' f Si •nature (Owner/Agent) a• .,. �� �-=� �% Date';�_/ :.BUILDING PERMIT PERMtT# DATE `VALUATION LOT i ' 00Y7.--023 TRACT. 2' BIX62W JOB SITE ADDRESS APN 1-780A,`irt}.F1I13A WLASC:O : '/'}.XJ.%a.M2 OWNER CONTRACTOR/DESIGNER/ENGINEER AM B1= -'Imo. PO BOX 297.. :13.300 FD I aa ` FJCIK LANE :PA11Id D SWr ' C::A. 92261 :�".�? DE EC;RT P -A 92261 '160)W 2905 USE OF PERMIT (JIY— FA S?' DWELLW 3 S.. i.7 ss PERMIT DOOM NOT I'NCldJDP, UI -DICK WA'L1,/POO1d3PA OR DRIVON.AY APPROACH TRACT CONSTRUCTION 1,3.34.00 %1? PORCT1fPXrI0 95.00 sip s rl .WOOD FENCE 200.00 V C 951 A,ill�, 446.09 SF .M C;C;4 ' 8) ' COMM ' ON'- .. . .;; '. ; ' . ) y•py�qq��l�pyy•99��� .+yypp���� gpq�},g.�gE1'{STMIA'1 5.17..ieJ.Y. Ir .1T !.AB:r 1, V 1.:+.bh`P A1Z i. C€33aC11'RUCTION YZE 101-0004,186000 Od�1.50 PLAN C;E1WK FRE 101-U00-439-318 $315.;41 MWHANIC L FEE '101.000-4211Q00 06100 FO T CTRiC.°.dti.. IES 1.91 VLUMBPAOki I-D'AAM-419 C1t10 $116.75 STRONG MOTION FEZ - RXESID 10'1-M-241 -000 $9.60 ORADiNO RX 101.4100-423-000 W.00 -. 19Ev1.I,0PJM''1MP.A.C3T ME �9,oS)7911 PRECISE PIA � � IO1�Ci(t0�4iA.��45 $10U.90 1+L�1.O 1=C�tiIT 101-:000-439.3'18;, •$�9Ei.9f1 FEB 1-6 $3,,,45817 ILESS PPAM PI! '�` 14250.00 T()'1`,iRJ;I.PMi! '�I�i'1��..DJUJ1 ,1400 A RECEIPT DAITE %J f � B'(t �;t� TE F INSPECTOR l!9 // t'AATA!/ �►` INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade y Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap .p �, F.A.U. Framing — ( —Ql Z' Compressor Insulation p ( Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PIN. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final 'Water Piping 7"1/1,0 1 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 Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) • - �p Y r,. TAtyl 0f�;K,rcv P.O. BOX 1504 APPLICATION ONLY Building/� 78-495 CALLE TAMPICO I Address, — gf / t/ (� �/� LA OUINTA, CALIFORNIA 92253 Owner ©ipl, BUILDING: TYPE'CONST._R6A=16CC. GRP. Mailing Address 7 A.P. Number 2 C) City ' Zip Tel 3 � _s Legal Description 7fi Contractor Project Description AA4 a"I Address A U Jay ��',► �,� Cityn Tel. & Classif. +<_1 I Lic. Arch., Engr., Designer Address _ Tel. X _ 960 1l oY ' Zip , (.�.�,x-,Ll, -ZQ - ,fie City C7- State Lic. # W LICENSED CONTRACTOR'S DECLARATION/ , I hereby affirm that I am licensed under provisions of C�.laptat 9 (comrfencing with Section 7000) of Division^3 al the Business and Pr Code+ aPnd my lice/nese is in full orce and effect. ` lF. J�. �1,/ J..� A1/l �.d �� SIGNATURE OWNER -BUILDER DECLARATION I hereby affirm\that I am exempt from the Contractoes License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, ester, 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 ($500). l: 1,as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I 11, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) I') I am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy N� 7 CompanySkf n Copy is filed with the city. O Certified copy is e&e furnished, CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($ 100) valuation or less.) 1 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 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 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 applicant Date Mailing Address City, State, Zip Sq. Ft./ No. No: DIN. Size .� Stories Units Newy Add ❑ Alter ❑ Repair ❑ Demolition ❑ imated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT 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: ate : Permit Validated by: UUV Validation: NO f _1,bl1 SIT Y tie LAU"" WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Notice: Document Cannot Be Duplicated' Desert Sands Unified School District 47-950 Dune Palms Road La Quinta, CA 92253. .760-7,71-8515 . CERTIFICATE OF COMPLIANCE Date 2/15/01 APN # 773-174-002 No. 21665 Jurisdiction La Quinta Owner NameJim Belknap Permit # 0012-023 No, 51-780 Street Avenida Velasco Log # city Palm Desert Zip 92261 Study Area Tract # Lot # Type of Development Single Family Residence Comments Square Footage 1554 No. of Units 1 At the present time, the Desert Sands 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 paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 2.05 X 1,554. or $ 3,185.70 the property, listed above and that building t permits and/or Certificates of Occupancy for this square footage in this proposed project may no-n'be issued Fees Paid B CC - Guaranty Federal Bank - James Belkna Thr° Y 7 Y Y p Tele..ane 760-83r.-1566 Name on the check wry By Dr. Doris Wilson Y s ri' Superintendent Fee collected /exe ;Annette Barlow Payment Received $3,185.70 Check No. 1769093 Signature NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) 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 sssued or on which they are paid to the District(s) or 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 - Applicant/Receipt Copy - Accounting DEC -05-00 09:51 FROM:FORESITE ESCROW ID:7607739269 PAGE 1 11Et.tiRDIN6 RzQIWSTED BY AND WREN R1i coavF9 MAtt. TO' JAMIES C. BELKNAP SEPARATE TRUST 32 Catnino Arroyo Placa Palm Dmart, CA 92260 A.P.N : 773474-111)2 TRAM Space Above This Linc fair R;ecarder's Use Only Order No.: 21740 Escrow No.: V32M GRANT DEED '191 t)NDERSIGNFA GRANTOR(%) DF.MARWs) THAT DOCUMENTARY TRANSFER TAX is: COUNTY $24.20 {X 1 computed on fill value ofpr r.Tty conveyed, or ) tmincorpamted :uea: ( X 1 city of Uinta , uld FOR A VALUABLE CONSIDERATION, Receipt of which is hmby acknowledged, Jams J. Yatton M.D. and F-Heen P40m. Trustm of the JAMES J. PATTON M.D. INC. AMENDED AND RESTATED EM PY.0''i OU RWMEARENi' TRUST. herebyNT(S to .lanm C. Btlknap, Jr. Trustee ortho JAMES C. BELKNAP EPARATE'lf9 UST, dated May S, 1992. �. . the following dt:.ccribed property in the City of lLR QadWp, County of Rivcmide State of California: 1,9ta 2, Black 62 of Satan Carntelits at Vale La Quints, Unit No. S, in the City of La Quints, County of Riverside, W. per map retarded in hook 18, Page(s) 63. in the orlacc of the Comty Recorder or said County, James J_ Patton M.D. and We= Palo, Trustees of the JAMES I PA•ITON M.A. INC. AMENDED AND AESTATED EMPLOYEES RE71REMEN TtUST. J J Paaan 4 .. Tluglce Eileen Patton, Trustee Document matt: S rtnber 7. 2000 STATE OF CAUFORN1A AS CotJRW gyp _ ALMS -.q-! f -c— s ) tin ?"L ZAOQ%a bctorc me. (Z.t,-^�, SCt ✓ v"1 Li 1��': permwIfyappeared dA+� �'s9rd�s1. ty QM �Nh it a prAuma2y4nvwn-Iv-= Or pmvcd fn me m the bUis of inti8 mmy evidence) in be the perto Nhrc onine mid acknowledged to the that ped xewtcd the� n kkftr w uwhcd eapaoirAWand dmi the permn(pr 4N cnrity own hehal v1 which the per''"' i; acted, executed the instmfoo t. wiTNisS'S n7 hand ofT�ial r � to Nc•witbin inttrutnent etrlCSloa the insttuttrctii This area for affk natuW scat.Cgne�on P Zl witoIliory �- COftfb� 11H!'CCR'IH'1�MDY1 alma up up W Mail Tax Stst�mcntc to: SAME AS ABOVE of Address Noted Be 4F�, �Iwc TOTAL PPGE.01 Krlc n RC DISTRICT - PLANNING REVIEW FORM 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 compatibility issues or need to require the filing of Master Design Guidelines by the applicant.' It shall be transmitted to the Building and Safety Department as your correction list. Please attach additional explanations as necessary. APPLICANT JAMES BELKNOP SITE ADDRESS 51-780 Avenida Velasco APN 771- 174 _ '00'2 BINNO.: CASE NO.: 2000-353 LEGAL: LOT 32 BLOCK 62 UNIT CHECKED BY: Stan Sawa DATE: Inform the assigned Building plan checker upon your assignment to this case: The CDD Executive Secretary maintains a log book to track applications and assign case numbers. REQUIRED ITEM Y N COMMENT/CORRECTION Compatibility Review V Case logged and number assigned Verify legal and APN information V Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98 Consistency with street/surrounding area: Colors Materials Architecture Other Requirements: Feb.22 01 04:39p p.2 Qom---� � (^, ; ��a -i� �5 Sladdep. Engineering 6782 Stan , t6h Ave., Suite E, Buena Pak CA 90621 (552) 864-4121 (714) 523-0952 Fax (714) 523-1369' 39-725 Garand Ln., Suite Gj Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895 Date I Job No. � 0 FIELD MEMO P 7) Client: Project Name Site Address Job Phone I . , )I X.1, . Work Done x.6\9' 90,*L .2%1111111=, Test Y I, Location Elev.DensitY Dry Moist % % Relative Compaction i' Ret. it '3 Comments wjp--� Aed Uch.j 9 of service. 24 hour'notice requOted, to..,sch6diale Feld Technician. Thank you for the opportunity portunity to b Certific-ate. of. a City of LaQuinta, 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:- 51-780 AVENIDA VELASC.O Use Classification: SFD. Bldg. Permit No.: 0012-023 Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RC Owner of Building: JIM BELKNAP _ Address: P.O. BOX 297 ' City: PALM DESERT, CA 92261 By: STEVE TRAXEL d,t, Date: 06-04-01 Building Official POST IN A CONSPICUOUS PLACE L