0309-091 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
a 0503 B C36 C42 HI I Irool2(
ate �, - ?r .- ? J' Signature of Contractor -j
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:
Carrier ;1TAT.P F�t1kdD Policy No. 15?6'33
(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.
Date: w Applicant
Warning: Failure to secure Workers' Compensation coverage 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.
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 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 purposes.
Y
Signature (Owner/Agent) �'G� Date /,,-
PERMIT PERMITH
.BUILDING
DATE VALUATION LOT 030"91 TRACT i
L) $97,394" 22 1YLTi 211
JOB SITE
APN
is
ADDRESS strR. Dprn
44
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JAWS C.13 t3.iC1YAP, JR:
JAWS C. BELXtTAP, J12.
73.300 W??riLY'NECK LANE
73-300 FiDDlE(M LANE
PAF -N1 DF,3ERJ' CA 92261
Pay.' pisirrr CA 92261
(760}777.9572 CBW X9(35
USE OF PERMIT
t
I NGU FA1VI1.LYDWD •LbIO
1604 &1. SFD 1'.ERVAIT f3C) s HOT INCLUDE HLOCK VTALI, PDOUSPA
OR DPJV&WAY APPROACH
TRACT C,'ONST1ZLIC. TION 1,60 ,00 SP
PORC".111PATIO 117.00 SP
GAR.A(WARPORT +146,00 3
1KaY.1.1L1 Alf. ` Y) C061=' 011' 4r,0.c VST R'U(, 10N
�11:1�:F� ��114 •
CONSTRUCTION FEE 101-000.418.000 $630.10 .
PLAN CHPX7X* FEZ 101-000439-318 $524.9-5
FEE DEPOSIT 101.000.439.318 415M0@ .
'MECHAN11", 101-000-421 -000 $59.00
FaLLC` RJCAL,IWF 161'.*000.4*20.000 $113,56
PLUMBINCI FEET 101-000419-000 $124.00
3TRC N0 MOTION FEZ- hE aU) 101-000.241-000 $9.74
OR-AD3NGf FEE 101-000-423-000 $15.00
�.
DEVELOPER IIMPA& FEE ' 5440.00
PRECISZ PLAN 101-000-441-34.5 51�f),ao
-TOTP& C.CPN;3a. UCT1.01,! AND PZAW C*MCK
$3,981.75
LEISU F:C7.1?-PPa 3 : -
423LW0
�
+p� �'+p
Q . 'V 9.=1•AJJ ,Z- .f:.RW- C S'.v S D Bi.' ,N 0 W
E a >V 19 2003
CITY OF LA QUINTA
FINANCE DEPT: '
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
-`s iG xis 1
k M
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR'
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.1C to Wrap
F.A.U.
Framing c7/_ O
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
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
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)
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District �q�cSlSlfU�„�.o
47950 Dune Palms Road
Q BERMUDA DUNES r
Date 11/19/03 La Quinta, CA 92253 (n RANCHO MIRAGE (�
WELLS
No. 25195 (760) 771-8515 ' INDIAN DESERT PALM DESERT y
LA QUINTA
. Gr 0 y)
O
Owner
James C. Belknap, Jr.
APN #
447-091-003
Address
73-300 Fiddleneck Lane
Jurisdiction
La Quinta
City
Palm Desert Zip 92261
Permit #
0309-091
Tract #
BLK 211
Study Area
Type
Single Family Residence
No. of Units
1
Lot # No. Street S.F.
Lot # No.
Street S.F.
Unit 1 22
53300 Eisenhower Drive 1604
Unit 6
Unit 2
Unit 7
Unit 3
Unit 8
Unit 4
Unit 9
Unit 5
Unit 10
Comments CC in the amount of $6,865.12 used for Cert #25195 and 25196.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiosANalkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that 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
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $2.14 X 1,604 S.F. or $3,432.56 have been paid 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 CC/LaJolla Bank - James C. Belknap, Jr Check No. 307519
Name on the check Telephone
Funding Residential
By Dr. Doris Wilson
Superintendent
Fee collected /exempted
Ivrey
Payment Recd
$3,432.56
$o.00
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the gMay 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 issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the Districtfs) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original - Building DepartmentlApplicant Copy - Applicant/Receipt Copy - Accounting
)i.L-...'r1-.r..7w.�-liV�v- �',�• ..4rnr�-h"Y� .+I � . A + Y-�: w �Y.�1'i �f�r..^ � -.. ~� � .� ,,,,,. � . �-. � ^ v -- � - a r l � , ��br� .^ � .
4
Sladden Engineering
6782 Stanton Ave., Suite A, Buena Park, CA 90621 (714) 523-0952 Fax (714) 523-1369
39-725 Garand Ln., Suite G, Palm Desert, CA 92211 (760) 772-3893 Fax (760) 772-3895
Date
Job,.No. ` �-
FIELD MEMO
Project Name Client:
Site Address �� ; -mac �t� r ,�v, yt,7•-�'�
Job Phone
Work Done
Test Summary / Footings Inspected
Test
No.
Location
Elev.
Dry
Density
Moist
%
% Relative
Compaction
Ref. Max
-'pcf
Moist
%
j
�° k h ``��► Dlz--
Comments I
I
Field Tech. Super. or Agent
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service..
ificate of Occupancy*
4
ilding & Safety Department
the requirements of Section 109 of the California Building
f issuance, this structure was in compliance with the
d .the various ordinances of the City regulating building
DDRESS: 53-300 EISENHOWER
Cert
0 0
1AM
OF B u
L w�
5
G� T9�
This Certificate is issued pursuant to
Code, certifying that, at the time o
provisions of the Building Code an
construction and/or use.
BUILDING A
Use classification: SFD _ Building Permit No.: 0309-091
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JAMES BELKNAP Address: 73-300 FIDDLENECK LANE
City, ST, ZIP: PALM DESERT CA 92260
By: KIRK KIRKLAND
Date: 10/01/04
Building Official
POST IN A CONSPICUOUS PLACE
ificate of Occupancy*
4
ilding & Safety Department
the requirements of Section 109 of the California Building
f issuance, this structure was in compliance with the
d .the various ordinances of the City regulating building
DDRESS: 53-300 EISENHOWER
Cert
0 0
1AM
OF B u
L w�
5
G� T9�
This Certificate is issued pursuant to
Code, certifying that, at the time o
provisions of the Building Code an
construction and/or use.
BUILDING A
Use classification: SFD _ Building Permit No.: 0309-091
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: JAMES BELKNAP Address: 73-300 FIDDLENECK LANE
City, ST, ZIP: PALM DESERT CA 92260
By: KIRK KIRKLAND
Date: 10/01/04