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0106-083 (SFD)LICENSED CONTRACTOR DECLARATION • �r• Thereby 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. C License # Lic. Class Exp. Date r1_ LO UJ cZ � tE7atecf�"' � Signature of Contractor~ ' �O� J U OWNER -BUILDER DECLARATION HUJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z( ) 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 Ln N Date Signature of Owner O C\1 Cl) Q WORKER'S COMPENSATION DECLARATION p ZCEI hereby affirm under penalty of perjury one of the following declarations: Lo FZ O ( a)"'I•have and will maintain a certificate of consent to self -insure for workers' X w LL- compensation, as provided for by Section 3700 of the Labor Code, for the O � Q performance of the work for which this permit is issued. m Q U ( ) I have and.will maintain workers' compensation insurance, as required by Q U Q Section 3700 of the Labor Code, for the performance of the work for which this LH permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier Policy No. Z) BXMIT J (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 3 subject to the workers' compensationprovisions of Section 3700 of the. Labor �Code, I shall,fo'rthwith comply with those provisions. Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensation coverage 1 unlawful and shall subject an employer to criminal penalties and civil fines up lo $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 4 application. 1. Each person upon whose behalf this application is made & each person at whose•request and for whose benefit work is performed under or pursuant to �\ any permit issued as a result of this applicaton agrees to, & shall, indemnify �rVip & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property, for inspection purposes. Signature (Owner/Agent) a}i r' dit D'ate�_?• %,�� BUILDING PERMIT PERMIT# DATE VALUATION LOT 01064M, TRACT O&VU : 05,954 ND a aix 1913 JOB SITE APN ADDRESS : �i-41M AWJnDA. 1MW— R%KRA '773-263-022 y OWNER CONTRACTOR/ DESIGNER/ EN INEER FO BOX 297 72 300M-DIMMM, S PALM Mulc 0A CR2'261 FJ'iLM D FIMT CA 92261 aa' (76)837<1566 116 2905 USE OF PERMIT - S_� - VAURA41T C1fi3.ES'NOT 1NL;Lt;T)F.8L,0CK'C'd.AL•1,iP i01,1�3;i A, OR D [?;U! A APPROACHI ` Rn AA TRAOT CAMST'RUCTJON 14 � 1,1 d�C�'i�E:'b'#/P.1 TIO I p(I Sig' JUN 1 l 2001 5 1'.OOD Pi UM FL Bii ;00 LV s 44000 Sp CITY OF LA Ot INTA FINANCE Of PT MVI R Ff 16TV STAMAR1t ~ G`.00 1STRUCIT1014 PT21jf):4.c112fT�41 -OiiO f37!<50 PLANT CIr1OCK' Fue t 101-f3i3Ct-4 �9-39 £� '�915.�1 M$i�:1'1,r�1�:iC'.6�.� lr''&,1? 9, fi1X-OS.►Cf-fi'21-($iiC 1;36.041 16L`'zTMC AL ME 11.81 P)riAM.l4UO Tip+A $1115.1 STRC?NO VIM= lrlml, - RESID 101-000-241-000 $9.50 OR&Trsil` O FEZ ) 0 f-00042' .4..13470 $30.00 DYW'R4.CIPIM IMPACT FUZ $1,907.0 PRE43ft. PLAN 101-000-441-345 8100100 ls`,F;C; ;ri:P03111.' 101-000-439-318 4250.00 MB -TOTAL 't'!$ ltC'1'ar47 �T� G'"`Yd Al$3,458.17 ;ESU MB-FA0PkI 4250,00 DATE I BY I DATE FINALED INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ _ Forms & Footings - _ Underground Ducts Ducts �s(® Slab Grade Return Air Steel Combustion Air Roof Deck 8 •. moi• O ( _ >;j'r Exhaust Fans 0. K. to Wrap 8_7. p( S� F.A.U. Framing 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 9/��D/ Final POOLS - SPAS BLOCKWALL APPROVALS 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�/ Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection('-� O'r �� Pool Cover Encapsulation Gas Piping Gas Test (� �7• 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) '-��-� ` �+✓� . � ��,. ��- �.+...✓----mow b" ob} off° � R Building `., 7), Maili T4 0 4 " P.O. BOX 1504 78-495 CALLE TAMPICO J1-AA,el, J LA QUINTA, CALIFORNIA 92253 el. State Lic.I City & Classif. Lic. q Arch., Engr., Designer ty' /((II Zip. ��/V, State g 9afi� 16(o Lic. 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.Business and Professions Code: Any city or county which requires a permit to construct, alter. improve, demolish, or repair any structure, prior fo'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 ($500). I: 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, 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 1 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 contractor(s) licensed pursuant to the Contractor's License Law.) i 7 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 C pensa ion Insurance, or a certifie copy thereof..(Sec. 3800, Lab ode.) Policy No. Gompany 1.7 '>� u-�'k— r7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work. for which this permit is issued, 1 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 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 sof this city to enter the above. mentioned property for inspection purposes. Signature of a0plicant Date Mailing Address City, State, Zip 1, 0000000 i .DING: TYPE'CONST. i_e . OCC. GRP. Number 775,-.2L5— ��' •-' A"o I Description Xet ft Ict Description 45.2— 446,57 I�d.P1L��LQc.Q°� Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 1i Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. 2 J �'- Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line drip Street Setback from Center Line Seth9ck from Qjroperty FINAL Issued by: III Date_ Validated by: PR 2 7 Validation: FINANCE DEPT WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION Desert Sands Unified School District 47-950 Dune Palms Road Notice: La Quinta, CA 92253 Document Cannot Be Duplicated 760-771-8515 CERTIFICATE OF COMPLIANCE Date 6/7/01 APN# 773-263-022 No. 22095 Jurisdiction La Quinta Owner Name Jim Belknap Permit # 0106-083 No, 52-465 Street Avenida Herrera Ug # city La Quinta Zip 92253 Study Area Tract # BLK 83 Lot # 11 Type of Development Single Family Residence ss. Comments Square Footage 1,554 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 r This certifies that. school facility fees imposed pursuant to f. Government Code 53080 in the amount of 2.05 X 1,554 or $ 3,185.70 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 CASH -Jim Belknap Telephone Name on the check By Dr. Doris Wilson a. Superintendent Fee collected /exempted by Paula Ruiz` Signature pad"" Payment Received Check No. $3,18.5.70 _ Lr • i . 40TICE: 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 rbove 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 rolled them on theDistrict('s)(s') behalf, whichever is earlier. Collector: Attach a -copy of county or city, plaii check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant ;''Copy - ApplicanMeceipt Copy - Accounting RECORDING REQUESTED BY AND WHEN RECORDED MAIL TO: James Belknap, Jr. Jacqueline L. Belknap 32 Camino Arroyo Place Palm Desert, CA 92260 0 A.P.N.: 773-263-022-2 TRA #: Space Above This Line for Recorder's Use Only Order No.: 33010234 Escrow No.: 2-33399 GRANT DEED THE UNDERSIGNED GRANTOR(s) DECLARE(s) THAT DOCUMENTARY TRANSFER TAX IS: COUNTY $30.80 ( X ] computed on full value of property conveyed, or [ ] computed on full value less value of (lens or encumbrances remaining at time of sale, [ ] unincorporated area; [ ] City of La Quinta , and FOR A VALUABLE CONSIDERATION, Receipt of which is hereby acknowledged, Donna K. Prendergast, r hereby GRANT(S) to James Belknap, Jr. and Jacqueline L. Belknap, Husband and Wife as Joint Tenants the following described property in the City of La Quinta, County of Riverside State of California; Lot 11 in Block 83 of Santa Carmelita at Vale La Quinta, Unit No. 10, as per map recorded in Book 18, Page 70, of Maps, in the Office of the County Recorder of said County. STATE OF CALIA )SS COUNTY OF 1, I I `e (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signature(s) on the instrument . the person(s) or the entity upon behalf of which the person(s) acted, executed the instrument. WITNES7a�no f6c 07—,,/ 1 Signator This area for official notarial seal. N+N�-------------- �.. L. GALLEGOS COMM. #1227860 NOTARY PUBLIC - CALIFORNIA RIVERSIDE COUNTY My Comm.. Exp. July 2, 2003 Mail Tax Statements to: SAME AS ABOVE or Address Noted Below I . ♦♦ 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 BELKNAP SITE ADDRESS 52-465. Avenida Herrera APN 773 - 263 - 0 2� ' BIN NO.: CASE NO.: 2001-457 LEGAL: LOT 11 BLOCK 83, UNIT S.C.@V.L.Q. CHECKED BY: Fred Baker 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 Caselogged and number assignedit-ft Verify legal and APN information nv PAIAUI IMM MpMENT DEPT ULF Consistent with MDG on file (as.applicable MDG filing required (5 filings since 9/3/98) EXHIBIT Consistency with street/surrounding area: Colors Materials Architecture Other Requirements: Sla, cIdt i 'E•ngineering `- 6782 Stanton Ave., Suite E, Buena Park, CA 90621 (562) 864-4121 (714) 523-0952 Fax (714) 523-1369 39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895 '1 ' ' ., J, ,i' J T;, 1 ^ 7' r u 2 7 •1< r: `V -��Fs �.LF y �. Date �' . ° . ., ^P .. ,, ', • S , .. - .�'' *, ^� :� ti IY..--?'�. c l ,r t.,tr '.. a+1 s; ^�.tYr" .... Job FIELD MEMO Project Name 5� - 'Q�c �c P- `r T Client: Site Address Job Phone �n� Qo�\4-� -Igck - 13 qA-al(1 Work Done Test Summary / Footings Inspected Test No. Location Elev. Dry Density Moist % % Relative Compaction Ref. Max pcf Moist % � . �•. / S- G U. S �� / 2 G Comments 1, •V r �1 Field Tech. Super. or Agent 24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service. Certificate of Occupancy City of La Quinta 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: Use Classification: Occupancy Group: SFD 52-465 AVENIDA HERRERA R 3 Type of Construction Owner of Building: JIM BELKNAP Building Official VN Address City Bldg. Permit No.: 0106-083 Land Use Zone: RC P.O. BOX 297 PALM DESERT, CA 92261 By: STEVE TRAXEL Date: 09-24-01 POST IN A CONSPICUOUS PLACE