9601-153 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 652815 D C36 8/31J96
.,License # L ic. Class "Exp. Date
;Date �,1,- I��r-;�, Signature ofContractor :.._ ,t,
OWNER -BUILDER DECLARATION
I hereby affirm 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).
() A, as "owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
() I am exemptunderSection B&P.C. for this reason
Date T , Signature of Owner
4 `
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 L atior- Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier'. .S"l~�0.'t;: tJty7) Policy No. 13"68204
(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 provisions. f
Dafe: i��- Applicant ,,. af, . r. E
Warning: Failure to secure Workers' Compensation coverage i/ unlawful and shall
subject tan 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 application agrees to,. & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work isnot commenced within ISO 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.
Signature (Owner/Agars) >l�t,. Date
ALC '
_BU.ILDING
PERMIT.
PERMIT, -�.
'y
DATE wl a b
VALUATION 0y". N -•
LOT a,1
TRACT '
JOB SITE ADDRESS 53,E Acv rr�l1a)A V.EL�
APN 773-326
OWNER
CONTRACTOR
1311KNAP CONSTR:OCl1.ON
-
JAMES .BELT NAP •� -
77836 MOME7,UMA.
P.O. BOX 291 ` .
LA QUINTA CA 42253
PALM."'DESERT CA 92260
(c5!9)5 A -M.3 CB1,# 2945
(619)564.2783 '
DESIGNER/ENGINEER
USE OF PERMITa I I
OenWt cines not.incluile block, wall or pool.
FEE DESCRIPTION
FEES t
TRACT CONSTRUMON 1,475.00 'SF
PORC I/pATIO 80.00 Sit'
GAR.AGWCARPORT 410.00 SF
MiMMED COST OF CONI STIZUCTION
99,192.50 '
PERMIT .f+°NE, SU.11+ItV1ARY
p
PLAN CHECK rE F 101-000-439.318 $505.965
CONISTRUC,'°1'lON f M 101-000-418-000 $594.50
ArIF,Ci{Aa�i1CAT : Lb 101-000-4.21-000 553.50
'�-
"
131 EC°1' UCAL FEE 101-000.4:20-ift $123.33
PLUWtNorF'f6 101-000.4194 W $.146,75
tiTONU 1� OHON FM! -12I� SID i 01-000-241.b0® $5.92
D o'
01Z.A1)1NG k'Isir:. 101-OM423-000 2u.o0 .
►ra
t'.laP}2A5tT1.21JC.CtSi3.E.:i�E'E 22S-000-441-;342 Si,;982:�9
I �
P.R ECIS.F 17(.AN 101-000441.345 $25.00.
Q� W
kFl Df�ty�JSiT �Z40.t)0 '
LL-
f
SUB-10TAL CONS''Ct UC;TIONT AND PLAN CHECK
$3,460.85
' LESS .PRE -PAID FEES
-s2m.00
TOTAL PERNUT-k I!,ES DUC NO
, $3,210.85
P
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs (p
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
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
BLOCKWALL APPROVALS
POOLS - SPAS
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 4ez
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
Appliances
Final
COMMENTS: //;;
�%lf��l1VN AW
/
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)
` . x.4.1.. Ik `f ,S.wl.,ihy F .i�. ,r•s'"^'wt-Y' ti. - t; I - .«..._..a-
-n; -. ,,':02-14=1996 02:55PM FROM � DSUSD—Fac i-1 it ies TO ' . 97777011 P.01 ,
41
Desert:Sinds. Unit R
Notice: ;,r82-879. Rig
� r 1CIId70, Ct
'Document Cannot Be Duplicated- IN 1
.,i '. 619-77:
.
CERTIFICATE O
,, .
Post -It `" brand tax transmittal memo 7671
x or pages ► l
To
From
Co. , . 1
co,
OEpt.
x.
Phone''
Fax 11 11-1 _10 I I
Fax t
Date 2/9/96 APN 9 T/3-'326-006
No. 14129 Jurisdiction La Quinta `
Owner .Namdames Belknap Permit #
No. 52-860 Street'' •Velasco tog y
City Ira Quinta ---- _ "Lip 92253 Study Area 112
i 475
Tract # Lot # Square Footage �
Type of Development Single Fatriily Residence _ No. of units
1
Commeots �.— --- --
. i
At the.present time; the Desert Sands -Unified School Districi does not collect fees on garages/carports. ;
covered patios/xvalkways. residential additions under 500rsquare feet, detached accessory structures or •
replacement mobilehomes. It has been determined the above-named o'Alller is exempt from paying
school fees at this time due to the following reason: i
EXEMPTION NO'l- APPOCABLE. j
This certifies that school facility fees .imposed pursuant. to.. Government Code 53080
in the amount of .1.72'' x 1,475 or $2,537.00
-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:
i
,Fees Paid By James Belknap Telephone 564-2783
:Name on the check.
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Ellen Patino havnient Received $2,537.00
Check. No. 5 j $ •
Signature '
Collector: Attach a copv of county or city plan check application form to district copy for all waivers.
i
Embossed original- Building Dept./Applicant Copy - ApplicantiReceipt Copy Accounting
:ran- 1t?''3h ,.uvi r .vz
y j " 007
°, ►xar,,� KY RECENED FOR RECORD
AT 8.00 O'CLOCK
'_ A�35 ?ai+,�SE FRs,Os"t3�it�Cf1 Win., t�.A
JAMES C. BELKNAP. !R.
• ?3?K90 fiddl�ch. Lr�c
PwM Uewt. CA $Z 61 s
�r�•:�-..,,. is r .-r-c� AV
y .
.>N'M..V.,A.F..A.
PAt7
Doc- Tranetat Tax
FRANK K. X)t- -,,0N
_ Mv. Co. Recwt w
JAN - 9r%
nw"w ip ase, a.w,
41....Wp0ft"11,.c+A11—
Uft fix *0cwdn•s IJs# � i
F -10"w No.: Y-1W1'1RS-
� y
Y%M tJwvvd "3vvM 00AY ORrst DwLtm01 T►tA.T v Y.4,X M: COLNTT p4_
X ) oortpctcd on full valve of oG`tirlYCd, or
cmorjted oQ fw] vshve ,Iia Vk to or "kni pr v nr+;s, n-Mv -Irs bt timc of "k,
mefecvtpcir�ad rtes: (?(� Ci:7 nr �9.• �
{�i [ R}I. V'�(��3.LbJ�pN1RyC.�£ay C�/^t Stt7�I)�/.A7'Ir7rN. RKrc/t•_pc of �h�kA�eL:v.,?Kre4ry wfo�+�w odgracY. .
4 � }•.1.�c�L.l rw�t kY,��V 'J'R 1-4�� 0.�yU 6L'i 1.r. 10 l•Qf?!r.9d'4�F1 �f9�}Qq yry,RY
G"k-A I i"t 04" to ..; A.k(T'S C. ? FT, KNNAP, .t'{R.. Trweet of Tom: 1A,WES IM71"AP S"ARA77 TRUST, 614.
i
(� ttt f*Mt-m l',.1g M'wcY+w propc* ,' In ttx City of IA Qrbftts, County of Rh k hart of Califarnia:
I LXGAL DVS( ?RFMON 15 ATTACH -.0 4i RETTI & BV TMS & VTTXY24CF IS A4AM A PART OF TIES
a GATM{, I-Tif"'.
gyp � • 'Cv K 11zeeQIM
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O+rermbeT 4, 145_.�Nev4v rM Cynthia
p *nir! repcseanE acseAll_K9.R1�_ _M.aG_:l ksld�il.rdpt �Op_.F-�xasiti�+'+r nF !Aam4 Wn '.Cju ply Co.
t�w�trs laa.rro r` .ae 1r PR" `� rR mr cw ew Mau of ue►cfs. snry n �a.xe) r h Are r4~W'sl awe runw.0 hl%m mhnTitkd in tM aidlin y'rrevvMm'
3M a! Oar ?111 It+�a't?r!e tstr 7rC� �r :s ttt M irslee�'6.rt �+rrpk Nrat ;-*Tw,n�i Hl sm ew M' h+0*Tr*Cir fjft*nr L1 on &W trtQntnlQA[
er pa.uwr.sl nr *w nrMy ur4'* fetrwtt M v!tw t ?x' rrv.�+r rt �+-rct• rae,:v+e,1 +1v am u}M"r. ,
o.'TTtV°�S ryry Rid sny,0-a a�4.-al +eat.
c y, n t h i t X i ERS C H'Tt, 7,rm an, hn oRCal mono *ars,
vire C0,130 et the
UrMed $1.1188 of 11 ,
America M61 Ts,% Ctatemrnts to: SAM. AS ABOVE of Addrt-vi Ntxtd Wow
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iDl lT.`r PD TEI.~ -'� X Jan: 16<'96 9:26 No;O�J1.P,03
Oar No. 201237
.e • . amp.
E tl9 I ■ofp "ONEG&
PAtaL 1
� 3'S?1' a� 860C1C J 01` SANTA CAtRM"A VNtT NO. 17 AS FtR MAP FtECOADf~p IN
ROOK 19 QAGE(S) 19 ANO 20 OF MAPS, iN Tlig-oMer-, OF THE COUNTY RECORDER Of
PNEIR3901 COUNTY,
LOTS ;if) ANO 21 Of BLOCK 161 OF SANTA CAnmELtTA AT VANE LA QUINTA UNtT 16 AS
ate® ! ECOM06D IN BOOK. 1 f1. p,otrE, 99 OF MAPS. RECORDS Of RRrE'ASaldf COUNTY,
•;ALQ!��af`�fJ�,
;I• �i il{i: ,. �, �� �� art
M1
Al
. I OF Tt�
t of ?�(outnc�i
det t1ttaion
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
C p 4 g
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:
'II ' BUILDING ADDRESS
52=$60 AVENIDA VELASCO
`i SINGLEFAMILY DWELLING 'Bldg. Permit No: 9601-153
Use Classification
R-3VN SR
Group Type Construction Fire Zone -Use tone
Y � .
James Belknap P.O. Box 297
. i Owner of Building Address
Gi'i �I Ill Palm Desert Ca. 92260
�I City Daniel P. CrawfCrd Jr.
By.
pots; July 9, ft -M), 9 6'
Building Official POST IN A aONe?IOuou! ►IACC