0110-103 (SFD)LICENSED CONTRACTOR DECLARATION
I'hereby 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
Pf6fessionals Code, and my License is in full force and effect.
License # Lic. Class - Exp. Date
C. C�1 � � 9/30/01
Date Signature of Contractor—
OWNER-BUILDER
ontractor 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-bj
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:
Carrier STATE M)ND Policy No: 157f0as
(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 provisl
ns.
Date: 'Applicant—
Warning:
Failure to secure Workers' Compensa Ti coverage is unlawful and
shall subject an employer to criminal penalties andcivil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on; his
application.
1. Each person upon whose behalf this application is made & each person of
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will'subject permit to cancellation.
I certify that -I have read this application and state that the above information is
correct. I agree to comply with all City, and. State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for,inspection p6rposes. ;
t Signature (OwnerhAgent) t I Date A)—
BUILDING PERMIT PERMT#
DATE VALUATION LOT Wit -10 "4 TRACT
F tl; B117- Ul2
JOB SITE APN
ADDRESS 4_ews.�-� TCFB.�E.wtx
OWNER I CONTRACTOR/DESIGNER/EN (NEER
-JAWRIS 01.EaE,E<K1`AP JAMkq. c,:. T3J : RAP, Jit,
RO^1 C) A 2.97 '3t30,rm1sL"1����t' i m. - F,
PAi,1 :1Y,1+RT CA 92261 !:>ALA&11,744 �?T CA 92 .1
USE OF PERMIT
Ey
STer) - l i):Y 9, MAST816, -CIASI NADit, I?&3ZAVI i DOES NOT 11dt;1.UqL
BLOCK WALIA sP-00.1ASPA OR. T1NWI EWAY AP PROAL; 4 %N
OC f 10 2001 u
:I OFYLAQUINTAF01AHPT
e7 f }6r��rr�
s9
.95
.UO
.00
.56
00
.40
,00
.00
-1i0`lf` L CONST.H'.,T$C^`.".t`, 014'. 41) .t l -.W C'.HECK 3,:5 1. :S
Um 4250.00
ttl RECEIPT DATE BY DATE FINALED INSPECTOR
3 _
I
5 T CONS x°R"�G`� 1n'; d,bl3�}.!iQ uT�'
PO3"st.ii?�'I.G
IFi3.00 Sk'
_CiS?lli.D'OH`T`
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RIM MADRID Coll -IT 01i"WHIMIRVITMOTT
Ff�ic:/�l:�tn�".C:�'E5411 �•�gy7a7AWIRY
.
NSiNX.11RUC f ION 1.11 !+
.101--000-4)81-000
2Rrf
$630
PLA34 C t3Lr;CK FEE
101-000439;418
45.29
W& Di POMT
-Za�AJ
A►11�f.;.@i1523tw:.R,1., ,i��
9 C91-i±q�-42 3 ••tJi10 -
�-�'3
MWIT R1C:AL IT119
101.000.420-0,00
P7.el3.M8i'10 ME,
101.000-419-000
00
ST)Ia'31,t'O SRO 1ON 'SI1'& - RKSID
101.4000 -'x.1.000
a�
ORA01140 YZE.
1.014"_4 3
DEVELOPIM IMPACT FEE
PRECISEP';.,AV
r
1t�'Z-tlrl:/fy<kP�'•:i*�:�
� lff�
OC f 10 2001 u
:I OFYLAQUINTAF01AHPT
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s9
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.00
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00
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,00
.00
-1i0`lf` L CONST.H'.,T$C^`.".t`, 014'. 41) .t l -.W C'.HECK 3,:5 1. :S
Um 4250.00
ttl RECEIPT DATE BY DATE FINALED INSPECTOR
3 _
I
INSPECTION RECORD
V OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS °,a MECHANICAL APPROVALS
Set Backs • _1 Underground Ducts
Forms &Footings Q 0 ( S Ducts
Slab GradeF/' . j ReturnAir ? ?.
Steel _ Combustion Air
Roof Deck Exhaust Fans r
O.K. to Wrap' ��r'f_U( f / F F.A.U.
!/_
Framing. _ Compressor
-L - Ul S —
Insulation �� ' Vents a
Fireplace P.L. • ,'I Grills
Fireplace T.O. ti Fans & Controls
Party Wail Insulation i ; . Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final -1 7 U 7:
Final POOLS - SPAS
BLOCKWALL APPROVALS: steel
Set Backs Electric Bond
Footings i Main Drain
Bond Beam Approval to Cover
}• _- Equipment Location
Underground Electric
I _ Underground Pibg. Test
Final Gas Pipi g
PLUMBING APPROVALS t . ' i Gas Test
1 Electric Final
Waste Lines _ i' Heater Final
Water Piping 10l`O-� S Plumbing Final
Plumbing Top Out "` Equipment Enclosure
Shower Pans O.K. for Finish Plaster
Sewer Lateral ; Pool Cover
Sewer Connection �OsZ �p �,� Encapsulation
Gas Piping
Gas Test / L •
Appliances
i ► Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS '
."Temp. Power'Pole
Underground Conduit j
Rough Wiring
Law Voltage Wiring t t
Fixtures. (3..
Main Service + )
Sub Panels ; r
Exterior Receptacles s
Smoke Detectors , +
Temp. Use of Power ,
Final/
Utility Notice (Perm) _ '
�
V OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS °,a MECHANICAL APPROVALS
Set Backs • _1 Underground Ducts
Forms &Footings Q 0 ( S Ducts
Slab GradeF/' . j ReturnAir ? ?.
Steel _ Combustion Air
Roof Deck Exhaust Fans r
O.K. to Wrap' ��r'f_U( f / F F.A.U.
!/_
Framing. _ Compressor
-L - Ul S —
Insulation �� ' Vents a
Fireplace P.L. • ,'I Grills
Fireplace T.O. ti Fans & Controls
Party Wail Insulation i ; . Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final -1 7 U 7:
Final POOLS - SPAS
BLOCKWALL APPROVALS: steel
Set Backs Electric Bond
Footings i Main Drain
Bond Beam Approval to Cover
}• _- Equipment Location
Underground Electric
I _ Underground Pibg. Test
Final Gas Pipi g
PLUMBING APPROVALS t . ' i Gas Test
1 Electric Final
Waste Lines _ i' Heater Final
Water Piping 10l`O-� S Plumbing Final
Plumbing Top Out "` Equipment Enclosure
Shower Pans O.K. for Finish Plaster
Sewer Lateral ; Pool Cover
Sewer Connection �OsZ �p �,� Encapsulation
Gas Piping
Gas Test / L •
Appliances
i ► Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS '
."Temp. Power'Pole
Underground Conduit j
Rough Wiring
Law Voltage Wiring t t
Fixtures. (3..
Main Service + )
Sub Panels ; r
Exterior Receptacles s
Smoke Detectors , +
Temp. Use of Power ,
Final/
Utility Notice (Perm) _ '
�
XC-erlificate bf.
Occupancyfi
:DJ
City. Of L
-a QU_nta Buildin
g yDepartment OFand Safet ��FM
TN
This Certificate issued pursuant to the requirements of Section 109 of the Uniform BuildingCode
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: 51-685 AVENIDA VILLA
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: -0110-103
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RC
Owner of Building: JAMES BELKNAP Address:. P.O. BOX 297
City: PALM- DESERT, CA 92261
By: RICHARD KIRKLAND
Date: JANUARY 16, 2002
Building Official ,
POST IN A CONSPICUOUS PLACE
�- X71"s�EiR"'7'��i?'�!'�;r�l'^�4"',,�� '7P-,�+F�j�►r �Y�•f�vl'��.swa'r+.'�yryq�.��f'�ji��a'
P.O. BOX 1504
Building/ / 78-495 CALLE TAMPICO
Address'57 - S 1` ( t �[,c LA QUINTA, CALIFORNIA 92253
Owner
I, t
Mailing ' BUILDING: TYPE CONST.
IL
Address A.P. Number i 3.
WFEM"",
APPLICATION ONLY .��
Q���
✓�—✓ OCC. GRP.
rz&
Lip Tel. Legal Description I
Confractort r / Project Description 1
Address , . , (� i_. V ,L.
�� G-t,�' � c.' • � ` 12,E ,�; E ,.
Cityt Zip Tel.
�� r -; i?
State Lic. City
& Classif. Lic. #C, ,^ 'j Sq. Ft.
Arch., Engr.,
Size
Designer
Address / Tel.
City ( Zip State ,^
Lic. #�t 7
' 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. 7031.5,8usiness 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 thealleged 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 (8500).
f.: I, as oner 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 Caw 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.) '
1*1 I, as owner of the property, am exclusivelycontracting 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.)
17 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 Co mpensation Insurance, ora certified copy thereof. (Sec..3800, Labor Code.)
Policy No. 1f. �,.4 Company r I r »/C._..... _ c.-
n Copy is filed with the city. 0 Certified copy is hereby 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.)
I certify that in the performance of thq 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
1hereby 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 1 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
New ❑
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
ZONE:
BY:
MDfi,�•uR
',En1SGN•`
Front Setback from Center Line
Rear Setback from Sear Prop. Line
Side Street Setbacl- from Center Line
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
2 f (i "'
Plan Chk. Bal.
Const.
Validation:
Mech.
Electrical
Plumbing
S.M.I.
Grading
�1
Driveway Enc.
Infrastructure
u[ 4 ^) , IINNN
TOTAL
��d iwtalC;E DEF T. I
REMARKS
r
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Sear Prop. Line
Side Street Setbacl- from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
rN�r
Notice:
Document Cannot Be Duplicated
'Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
1
Date 10/10/01 APN # 7t3-143-021
No. 22570 Jurisdiction La Quinta,
Owner NameJames C. Belknap Permit #
No.' 51-685 Street Avenida Villa Log It
city La Quinta zip 92253 Study Area
Tract # BI 12 U 12 Lot # 9 Square Footage 1604
Type of Development Single Family Residence No. of Units . 1
Comms nts "
a cashier's check for 3 single family dwellings.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered i
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacerwrit 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 1,604 or $ 3,288.20 the property listed above and that builc.ing
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 C. Belknap, Jr.n-e
Teleplione 760'-837=1566
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exem ted by Annette Barlow Payment Received $9,864,60
] r, Check No. 302530
Signature
OTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest theoffees or other payment identified
Bove will begin to run from the date an 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
31lect 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
c
it
'jiBELII Y �` "tiURi : ICF_ CO. DOC, a. Fss:9.e0
Pa06 l of 2 not T Is% 9" ,
lNL#M1A wvir fitL VIVISIU(V Ra�y�d In Offlolsl Rseord■
• '� l Okay of Rlwreld■
BECOMING ABQtIFS'OMZV Gary L. Oreo Ra�ard■� � 't
r Aaa■t�� �1y Clark 1,
��R=R = MAIL TO:
)atnei C. Bacnap. Jr., Trustee
32 6=dLno Arroyo place
pgo Desert. CA- 92260
-rim oZ,o -017
i73-LoZ�opz � `
111
III
1
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I
I
1�
II
II
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1
PeDA
e,ff
A R L
,.....�....,G uac 1% w7
Escrow No:2-34M.1
A.P.N.: TRAM O 1 Order NO.: 330 1707
.'
01
019, GRANT DEED AG
616
UNDERSTGNED'GttANTOR(s) DECLARB(6) THAT DOCUMENTARY TRANSFER TAX 1S: COUNTY 143 00
X ] computed on full value of property conveyed, or rime of sale. .
] computed ou full value less Ci rue lli or m c brattces Mfllaining at
unincorporamd area: I X l City —�--�
FOR A VALUABLE CONSIDERATION, Receipt of which is brachy adtnowledgod,
SOU rEWORK ENTERPRMS, INC., a CallitOT02 Corporation
hereby GRANT(S) to James C. Belknap, Jr., Trmtee of the James Belknap Sepante Trust dated May 3, 1992
the following'described property in the City of La Quinta, County of Mvenide State of California; } L
See Exhibit "N' attached hereto and inade a part hereof; /
SOUTHFORK ISES. INC., a
California t
By: `
zcnn3.*CF0
iBy`
Document Data: August 14 OOI "
STATS OF CAL ORN eke—:)
)SS �
COUNTY OF
bchn mc. o
rhk
aM
��' appared s whose names) Maze wbsuibrd to the widths inrMM=
W.
n,a (or proved to ms on the basis of setisfietory eridee¢e) b be ftpc8on( )
and ackmowlodged to me tha<h "ajdtey eaewted the umc iUbW41 r/their=dmdrsd capaeity(ies) and d,ar bybirlketAheir signantr6(s) on •tl,c nne
immar
the pcma(s) or the Canty Upon bebdf of which the perAn(s) acted. executed the casttmosnt.
WITNESS joylkind aad ofttcid seal- + r
This am for ufficiat nomrid seol. ;
W
ARGO KNAPP y
coew.stno MARGO
p1JUIC-CALILOS F
u l OP.FFM 14,E
Mail Tax Statements to: SAME AS ABOVE or Address Noted Below
Order: X Description: 2001.430067 Page 1 of 2 Ca=ent:
VIUCI IVU. JJVL`I / V /
EXHIBIT ,,ONE"
Parcel 1:
Lot 11 in Blockr38 of,Santa Carmelita at Valel'a Quinta, "Unit No. 3 ds shown by. Map on
6Z2File in Book 18 Page 59 of Maps; records of Riverside .County, California.
Parcel 2:
ely� , o Lot 9,"Blook'-1"12, Santa Carmelita Unit No.. 12; -as shown by Map on file in Book 18 Pages
79 and 80 of Maps, Riverside County Records. ;
Parcel 3:
Lot 1, Block 41 of Santa Carmelita at Vale La ,Quinta, Unit No. 3, as per Map recorded in
-7 % 2 ala°' ppl Book 18, Page 59, of Maps, in the Office of the County Recorder of Riverside County.
Parcel 4:
7 73 ,ZZ -5 -01. . Lot 8 -in Block 92 of Santa Carmelita at Vale La Quinta Unit No. 11. as per Map recorded in
Book 18, Page 75 of Maps in the Office of the County Recorder of Riverside County.
Parcel 5:
Lot 5 in Block 11 of Santa Carmelita at Vale La'Quinta Unit No: 1 as per Map recorded in
772j 2 5 4%a-016Book 18, Page 46, of Maps, in the Office of the County Recorder of Riverside County.
s 2.35
t
2
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 per Section 9.50.090 of the Zoning .Code. Its purpose is to determine:
1) that the proposed house design does not duplicate the same architectural style of any.
house witFiin 200"feet of the applicant; and/or -2) -if -there is -a -need for the applicant to file for
Master Design Guidelines.. If the applicant does need to file a Master Desidn Guideline, please
transmitted this information to the Building and Safety Department as part of your correction
list. Please attach additional explanations as necessary.
APPLICANT Belknap Construction
SITE ADDRESS 51-685 Avenida villa '
APN 773 _ 143 _ 021 CASE NO.: 2001-5.58
LEGAL: LOT 9 BLOCK 112- UNIT S.C.@V:L.Q.`
CHECK AND APPROVED BY: Michele Rambo 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
Verify legal and-APN,. information
,
Consistent with MDG on file (as
applicable
F�
MDG filing required (5 filings since
9/3/98)oo
pFvq
Architectural variety within 200 feet of
the surrounding area:
' Colors
Materials
Architectural design features
�00yG0
Other Requirements: .