15628 (SFD)P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 78--628 Ave. Tii j>inga LA QUINTA, CALIFORNIA 92253
Owner James Belknan
No. x.562$
Mailing
BUILDING: TYPE CONST. WN OCC: GRP. R3
Address P.Q. BOX 297 A.P. Number 769--462- 008
City_ Zip Tel. ' ' Lot .24 Desert Club Bract Unit S
Palm Desert, k 92261 564-2783 Legal Description
Contractor BFd
Construction
Address
P.O. Box 297
Palm Desert, Cep 92261
State Lic. B. 652815
& Classif.
Arch., Engr:,
— Designer
Address
'564-2383
City 2845
Lic. #
0
City Zip State
Lic. #
.LICENSED CONTRACTOR'S DECLARATION
Ifhere y affirm that I am licensed under -provisions of Chapter (commencing with Section
7000) Mot 3 of the;Business and P fessions Code, and m�j license is in full force and
_effec0-1 1 . I.
JIUrvAIUnC •^��M YUAII
/r)) OWNER -BUILDER DECLARATI
I hereby affirm 'that I am exempt from the Contractor's YLicense Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, Improve, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to rile 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 rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the stricture is not intended or offered for sale. (Sec. 7044, Suisness 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
orimprovement 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, 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.)
❑ 1 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 CP pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NP. - Company
Vopy 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 (E 100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any pparson in any manner so as to become subject to the Workers' Compensation
Laws of Callf0 nf&
Date Owner
NOTICE TO APPLICANT. d, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($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.
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.
1 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
Project Description
Sq. Ft.No.
Size . 1970 Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑
Permit includes 148 1.f. of 5E r:
garden wall along Calle Quite to.
to house. Additional walls, ret
and pool permits -to be obtained
uemoImon u .
r
i .
Estimated Valuation
4127011.00
Minimum Setback Distances:
r
PERMIT
Front Setback from Center Line
AMOUNT
b'
Plan Chk. Dep.
250.00
Side Street Setback from Center Line
Plan Chk. Bal.
Side Setback from Property Line
364.15
Const.
INSPECTOR
737.50
Mech. -
-
62.00 .
Electrical
147., 33
Plumbing
138.00 ..
S.M.I.
12.73
Grading
20.00
Driveway Enc.
00
Infrastructure
2 r 734„ 95.
Arts in Publ .c . P'laces
68.28
Precise Plan
25.00
TOTAL
•4,559.94
4,3Q9.9A!
REMARKS
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
i
Validated by:
n
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PL
IST FL. SQ. FT. ® $
UNITS
r�
2ND FL. SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
FOR. SQ. FT. ®
SEW OR SE 9j
ROUGH WIRING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.WOWS—Aw
GAS (ROUGH) �
DRAINAGE PIPING
CAR P. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SQ. FT.
GAS (FINAL)
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FlfJAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
�J
FINAL INSP. �Q /
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
LATHING G II
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 V. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
FINAL INSPECTION/ /
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE HPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMEIN /� ��
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 9�
SEW OR SE 9j
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.WOWS—Aw
GAS (ROUGH) �
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FlfJAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$ _$
LUMBER GR.
�J
FINAL INSP. �Q /
w
FRAMING
FINAL INSP.
ROOFING
i
!/(•
/
/
jJ'yu/Ji �L`xa
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING G II
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION/ /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82 79 H' h
78 ig way 111
NOTICE: Indio, CA 92201.
Document Cannot Be Duplicated 619-775-3500
Date 8/10/95 Type of Permit La Quinta
No. 13607 Permit .# .
Log
Owner Name James Belknap.
No. 78-628 .Street Ave. Tujunga.
City 'La' Quinta Zip 92253 Study Area 125
APN # 769.-062-008 Tract,# I Lot # Square Footage 11970,
Type of Development, Single Family Residence No. of units
Comments • '
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 1.72 x 1970 or $ 3,388:40•• have been .paid to D.S.U.S.D. 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 James .C. Belknap, J. Telephone`, s X41-2271
-- Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected/exempted by Pauline Pearson y • *4,� -
Payment IZ.ecbwPd:-• r z
Signature �, ; D p �� t n ,n_,��, $3,388 40� `' cNo� 1526
Check .
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
AUG -02— 95 WED 12:34 .1 ll: D I X I E 'ESCROW CUMF'i..hlY _.TEL 1110:619 568;628342 P0190
.
RECORDING REQUESTED BY:
Deed recorded August -1, 1995 as Instrument 11249595
with Riverside County Recorder,
When Racorded (Mail Document
and Tex Statement To:
Juwee C. Belknap, Ji.', Trustee CERTIfl 0T T UFANO
C
P.O. Box 297 O ltEC OP OF OAl01NAL
CRO COM NY IN •
Palm Desert, CA 92261. K
Escrow No. 9981 -LF
Title Order No. SPACE ABOVE THIS LINE FOR RECORDER'S USE
a?N: 769-062-008-8 . GRANT DEED
Code: 020016
1'ho undersi Yned grantor(a) deSl�re(
:hacumentr~r tranafor tax IS $ City tax'$
X Y computed on full value of property conveyed, or
. computed on full value fess value of lions or encumbrances remaining at time of sale,
(. I Unincorporated Area City of T,A, (�,►tnt-a
1:0R A VALUA13LE CONSIDERATION, receipt of whichis hereby acknowledged,
SHARON L. SZESNY,.a married woman, who acquired title as SHARON LTDOMEY, a married
wprnan - •
hereby GRANT(S) to:
JNAES C: BELKNAP, JR., TRUSTEE OF THE JAMES BELRNAP SEPARATE TRUST DATED MAY 5, 1992
the following described real property: in the City of La Quinta
County of Riverside State of California:
Lot 2.O of DESERT.CLUB TRACT UNIT:#5'as per'map recorded in book 21, pages 61• and.62
of Maps,- Records of Riverside County, California.:
DATto:May 26, 1995 ,
STATE OF CALIF,QRNIA
COUNTY OF Sharon L. •Szesny
�Jhl _5 before me,
pereanally appeared
-�-� L es X11/ _
F' (or proved to me on the - -
basis of satisfactory evidence) to be the person(ti} L,1;pfNfi ��c�AN
whose names) ISM% subscribed to the within Comm, #9 LO
instrumsnt and acknowledged to me that shaflhey- Hutgy rc �uaoft 0
executed the same in- hk/her/t�eits--authorized
'capscity(ies), and that by I iVher/!heirsI nature(s).on
the instrume t the erson(s), or th entity upon
behI'll of w i t er a executed the
instrume t
Witn ss f lel seal
Sig 8tur
i
BILLINCiTON w o �''s,.znC Pr;c;r " ,r' i
. , rw� M 7- „>„y •� p j''� iii S.p�* �" •J. M,O. h1t'i. e�VEi%• °4�ni 7
1 + s�lwil.,n.q!,a�'� e� 11 EHITIFI�h.1ATt6. at,
F iLUERAL EMERGENCY MANAGEMENT AGENCY
�. i�n<<`>bt 1'41m F40OuJ INSURANClr PROGRAM
AT + i:''a T N tf,li Oise. ti:?'; cor!li;; ate : rf ; nut provide a waiver of the flood Insurance purchase requirement. This form is used only to
rt+-i+/i{i� eiev !;ion II icrr,tilor r.9ce'.sary to eneurs compliance with applicable community floodplain management ordinances, to
dttten.;"1eiti wmrr,:ie Premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMM). .
;instructions for completing this form can be found on the following pages,
SECTION A PROPERTY INFORMATION
FbFt tNSUt=;1`,ra F, ;{WFtj`r' ii:3E
BUILDING OWNER'S NAME POLICY HUMBFA
"'7ir'.+_ r Al:jal?ES;.o i,rwiuU!!'� ,"s t . Ur*;. ti.,,L•e �i!C.or a;7y�,
N'
sr,tr [t17 �O. nOUTtw ANO — N---- - - _ _- ----------- .. - E
7 BOX UMBER 4OMPANY NAIL tyUkJ.Bc:FR
(7intFait tJ�;.SV'�UPTr{)^i ; @f ki!:9 ti`ak. i'': J,.,.J�,'& �h- - --- ---...�__�_____------•---- •---._._._...---- •^------------ - - - ------------'•-,.,al
DE: -ej. t: C-1i.Lb T:r: ac t, Unit No..61-64
.Lc_ c'-al.i ita SLATE ZiP CODE -T
CA. 92253
SECTION R FLOOD INSURANCE MATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
i. COMMUNITY NUMBER 2, PANEL N{IMBER 3. SUFFIX 4, GATE OF FIRM INDEX
060709 OOi15 B Aug. 19, 1991
S. FIRM ZONE T y 8. BASE FV•.109 .I .;y�r,,�..•_.. _.� r
A O ,
7, Indicaie the elevation datura system used on the FIRM for Base Flood Elevations (SFE): k1NGV0'29 ❑Other (describe on back)
8. For Zones A or V, where nc: BFE is provided on the FIRM, and the community has estabiished a BFE for this building site, indicate I
the community's BF'E: L-l.._l..!._i.J.L I teat NGVD (or other FIRM datum -see Section t3, Item 7).
SECTiQN C BUILDING ELEVATION INFORMATION-"�-
1. I-Isina the Ele,. imk.i'• ': rt;l« >�(F, instructions, indicate the diagram number from the diagrams found an Pages 5 and 6 that hest
describes the i t:h'i?-,, boltding's reference leval
2(a). FIRM Zones Ai A30, AE, AK, and A (with BFE), The top of the reference level Noor from the'selected dlagrnm is al an f' :'1ilb�, t
root NGVE, (or other FIRM datum -see Section 8, Item 7).
FIF"I") 7one!.l'1.1.44'30, ', e.nd V (v,;ih erE.', The bottom of the lowest horizontal structural member of the reference fev6lzfr,�M
Girl ;r;ir3cted OiA4rgrtt, ,s at ar, Vevairor, 01H _ { JJ,L.__; feet NGVD (or other FiRM datum -see Section" B, item
(c). FIRM Zone A (without BFE), The floor used as the reference level from the sefscted diagram Is (J -J.0 feet above ❑ or
below ❑ (check one) the highest grade adjacent to the building, r
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram Is Llg),&I feet above Q or below 0 (check
one) the highest grade adjacent io the building. If no flood depth number is aveilable,.ls the building's lowest floor (tolerance
level) elevated in accordance with the coin rnunily'S floodplain management ordinance? L.', Yes (-J No VJ ljnlown
3. Indicate the elevation datum system used in determining the above reference level elevations: (�] NG-`vV V rlv,,er (den i
under Comments on Page 2). (NOTE: If the elevation datum used in mgasuring the elevations is different fhan ,har rrcerj or,
the FIRM [see Section B, Item 71, then convert the elevations to the datum system used on the FIRM and show tlrt� Convorsio n
equation under Comments on Page 2,)
4. Elevation tolerance mark used appears on FIRM: l0' You ❑ No (See Instructions on Page 4)
5. The reference level elevation Is based on: U actual construction ❑ construction drawings
(NOTE: Use of construction drawings Is only valid if the building does not yet have Ilia reference level floor in place, In which
case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
will be required once construction is complete.)
6, The elevation of the lowest grade Immediately adjacent Io the building is: LLLDJ.�J .J .feet NGVD (or other FiRhi i;:ii,i,I l•&e t•
' L Section 13, Item ; ),
,
SECTION b COMMUNITY INFORMATION -
1. If the community official responsible for verifying building elevations specifies that the reference level Indicated in Section C, Item 1
+• Is not the'"lowest floor" as defined in the communfly's floodplain management Ordinance, the elevation of the building's 'lowest
floor" as defined by tha ordinance is:~I_LI—i_i_):�._ I teal NGVD (or other FIRM datum. -see Section 8, Item 7).
' 2, Date of the -start of construction or substantial improvement
'. ; FEMA Form 81.31,�tv1AY 93 REPLACES ALL PREVIOUS EOIt IONS SEE REVERSE SIDE FOR COvTR NA CNI -
* s ,,1:15/19-35 11:20 Si 931232690
BILLINi�TUhl AND ASSOC PAGEvl� '
SECTION E CEATIFICA710N
Tills certilication is to be signed by a laF* 'st,rveyor; engineer, or^archltect wtio is authorized by state or local law',,-,ys� t,l, ,; •,3t.r
infonnailon when the elevation Inlonnation for Zones Al -A30, AE, AN, A (with 8FE),V1-V30,VE, and V (with SFFif* tg�liJtr@ l:
Community ofliclais who are authorized by local law or ordinance to provide floodplain managemRnl Inrormatlori�' t ia; ,31,tn -ei,,,gl,;; }`
certification. In the case o', Zones AQ and A (without a FEMA or communlly Issued f3FE), a building official, a. papal ty owner, or;
owner's representative may also sign the certification, ►
Reference level. diagrams 6, 7 and 8 - Distinguishing Features -It the certifier is unable to certify to breakawaylnon•breakaway wa!
enclosure size,'►ocallon;of servicing ecluitzment, area use, wall npeningg, or unfinished area Fealure(s), then list the Features? no
included in the certilication under Cornments below, The diagram number, Section C, liern 1, must still be entered. ,
1 cedify that ilia information in Sections B and C on this ceriilicate represents my best eticrte to interpret th tfikAt
I trnders;and that aoy farse stalomom may be fxmishable by fine or imprisonment udder it; U.S. Code, S Vie` si�>
FL'1'E 13ILLTI'dG'1>7Id
P.L.S. RD ` 4'
t
CERTIFIERS rJl1ME t.ICEhISl= NUMBER (or.Ar!iv Seal) •�.
FECf✓ 13ILLINGIVI4 & ASSOCIATES,
r
INC� �F,rp us•3u•�a
TIrIQ COMPANY NAME— —---------- — -----
_1_1 US N. GIME AUTRY ti'RAIL, STE. b pAU1 SPRINGS, CFi 92262 sl. P��� r.
AOORESS 7— CITY—
Qa, (519) 323-4 A
S,(ar•Ir.rUriF' DATE CNONE-�
Copies should be made of tills Certificate tor. 1) community official, 2) insurance agent/company, and 3i building owner,
COMMENTS: ___. Building -is c:anetnir,,ed nu a d rt--,
�. pad
above the highest adjacent street curb. This building has beOn consrria ted
wlth,, Lhe requirements of the �_ } g -gam The building building therefore ccxpplies with the requirg_rrtents of lath the local
' lei It-7W'fd-the--#?%ftifi :._ v _ — - --- --- - -- -� a
It appears that at least one (1) ft. of fill was placed on t -ie Lit vrior
--toc�5ns�rac:fi7t7 of-f'e s La` y.
%
,
, �d.e►nrra:0
n.ze
tnW
ELEVArNil
.•• • Orl
$LAg
A v
YuNe9 ZONES
. � ADM^.EHI
-it _rt AHJA."F11r Gmue
WIL UnADE
F
�Ab�Mlri!
A
Ir zoNEN
We
4000
EL {VA1 iC_Q
vrtna, cn cc�:uMc�r/
A.
The dlayrants above illustrate the points at which the elevations should be measured In A Zorres and V Zortes.
Elevatluns for all A Zones should be measured al the lop of the referenoe level floor.
Elevations for all V Zones sliould be measured at the bottom of the iowesi horizontal structural rnarabio. !I
Fage 2
r
T� C
OFFICE OF THE
AGRICULTURAL COMMISSIONER
CALVIN C. KAMINSY,I
J
P.O.'DOX 1009.
*O'��OM
Assistant Commisslonc.
•r0 ^J`
RIVEosibr-_ CA 92502-1089 - -
JAMES O. WALLACE PHONE (909) 275-3000
`DAN RILEY
Snaler. Wolohrs & M961:
Aprlcuitvrol Commissloner FAX (909) 2753012
(909)'275-3030
• DIrecloi of Welphh & Measures
FAX (909) 2164728
83-612 Avenue 45 Suite,?
Indio, CA 92201
! (.619)863-829
Dn>r _
z-\ �:5 _ cnsr NO. 07
T.� c,5 •
DENELOPER's NAME:ADDRE
I
Dear Developer:
After ',reviewing your landscapiTI9 hla.ns, all plant mater.i.al
1•isted is' riot in
violation of quarantine 'laws governing the Coachella •Valley..:
If substitutions
y do' occur. and they differ from plant- material.-li's_ted,,'..this
office- must be
'i notified imme(liately:
i Thank• .. •
you for protecting aIl(] presezv:ing the' Coach,e11z1., Valley's
pest-free
r environment.
Agricultural Cotitmissioner's ffice
cc:. Indio.and Riverside
I I o a
Iv99�
of
��
(t�
Vu*nta
►n lltto t tIII
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building.
�j 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:
k 78-628 Avenida Tujunga
j BUILDING ADDRESS
Use Classification Single Family Dwelling Bldg. Permit No. 15628
!; Group R3 Type Construction VN Fire Zone Use Zone SR
�� ji it - - - •• _ .
Owner of Building James Belknap Address P.O.' Box 297
Palm Desert CA. 92261
City. Daniel P. -Crawford Jr.
Dote. December 18; 1995 .
0,
Building Officl al_b ►WJT IN A OONtTICUOUs PLACE