0309-092 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
CY
LU 205031 13 C.36 C42 kit 111 WE
Z r,- Dated., - Signature of Contractor
O�, / . I ;.---
F- OWNER -BUILDER DECLARATION
UJ W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a i License Law for the following reason:
Z ( ) 1, 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
f; 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).
1rc0 ,O I am exempt under Section •, B&P.C. for this reason
LO
N Date Signature of Owner
ON
rn
d Z WORKER'S COMPENSATION DECLARATION
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
LID O () 1 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
mJ Q performance of the work for which this permit is issued.
Q U ; ( ) ; 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
1. rn F- . ;.permit is issued. My workers' compensation insurance carrier & policy no. are:
Camer STATEnFU" Policy No. l3Y67$9
.(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
1 ' ' workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
I , Code, I shall forthwith comply with those provisions.
Applicant
Warriing: 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
a of the Labor„Code, interest and attorney's fees.
`t IMPORTANT Application is hereby made to the Director of Building and Safety
PP Y 9 Y
for a permit subject to the, conditions and restrictions set forth on his
application.
l 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 D
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.
i
V1 Signature (Owner%A'gent)=/ Date !
BUILDING PERMIT PERMIT #'
DATE VALUATION LOT TRACT
7,W4JEi 21 'k LK 211
JOB SITE ADDRESS ��-320 i��O'�d�. M DIh�'X
APN 447-C91AM
OWNER
CONTRACTOR / DESIGNER % EN 1NEER
JAMM C. I3�� AP, JR,
TAWS t ..SREMW, SR, .
73.300 FIDDL,lM(W. LANE
73.300 _MDDLM4,4_CX 7.url l9
pA; DWERT CA 92261
PALM DEMMT 'CA 92261
(760)777-95.72 l" BVI 2905
USE OF PERMIT
Ff1iY.6#.I+j{��t Myv
YO2.JM /VY%LOL.R�i
f
1604 S.W. SPD PERMIT DOM NOT INCLUDE 5WC1C'S A1.110 P00USP.>3C.
OR, DRIVEWAY 75%i41s:9 UCLD PL&M CHECK FEC FOR
MULTIPIZ PLANS OF SAME TY'PX ,
TRACT CONSTRUC'T19N 1,649.00 Si*'
PORCa IRATIO 117.00 SIS
0ARAOFICARPOAT 44+6.00 1;P'
ES 1,70 COITr Or, t:.'C3,I` TRUE:'ITON
97, 39490
PM. VUT PRE sL7 y
C014STRUCT3`ION FRE 101-000.418.000 $630.54
PLAN CHECK FEE 101-000-439-318 $131.24
FU Ui+i'f, W 101.000-439.318 4250.04
MECYtANIC'AL 1?ElL 1.01-000-4.21-000 SSS.00
MAC T. RIM, FEE 101-0007,0.000 - $113,56
PLUMINOIf Y, 104-000-.419-000 $124.00
'
0TRO'N01a/ OTIO14 FEE - IIESID 101 -0004A.1,000 $9.74
GR.ADINO ME 101-000-423-000
i)i3Vi1.,C PER IMPACT PRF. C440S.00
9.REC1SEP KN 3.61-00€J-.411- :i $100.00
S. B- AL C C)MMUC7. 10 oi.P.J DLAY%C'•. MCY
$3,58S.04.
Q L&W Pte. -.PAW FP..,FS
4250:00
0,
cC9�
R
DATE '� �`!i7
BY ✓ f'DAT
ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
7
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof,Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
– —
Compressor
Insulation p
Vents
Fireplace P.L.
Griffis
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 Pibg, 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
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 – Y
Final
Utility Notice (Perm)
COMMENTS:
--
-
-
Date 11/19/03
No. 25196
Owner
James C. Belknap, Jr.
Address
73-300 Fiddleneck Lane
City
Palm Desert Zip 92261
Tract #
BLK 211
Type
Single Family Residence
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
Lot # No. Street
Unit 1 21 53320 Eisenhower Drive
Unit 2
Unit 3
Unit 4
Unit 5
APN #
Jurisdiction
Permit #
Study Area
No. of Units
S.F. Lot # No.
1604 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
Comments CC in the amount of $6,865.12 used for Cert #25195 and 25196.
q ti. O
Q BERMUDA DUNES
r/] RANCHO MIRAGE 0
INDIAN WELLS
PALM DESERT ,y
LA QUINTA
Q INDIO
0
447-091-004
La Quinta
0309-092
1
Street
S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, 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 collec
Signature
Payment Recd
$3,432.56
$0.00
Over/Under
NOTICE: Pursuant to Government Code Section 66020(d)(1), s III serve to notify you that the 90 -day 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 District(s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
1
Embossed Original - Building Department/Applicant Copy - Applicant/Receipt Copy - Accounting
(wSladden 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 12-�i
Job No.
1
FIELD MEMO
Project Name ►.1 n w S.Q -'�... �i Client:
Site Address 53 --5,2 0�, ... hat.�P✓ °
L .v 6 "1 t
Job Phone
Work Done
Test Summary / Footings Inspected ,
TestDry
,vNo.
Location �%
Elev.
Density
Moist
%
% Relative
Compaction
Ref. Max
pcf
Moist
%
/l7. /
5-6
)19
} 2 1
" 2
V
• � z✓ !
�. S P_ N (• is w e'v ; tz—
i
Comments
Field Tech. Super. or Agent
24 hour notice requested to schedule Field Technician. Thank you for the opportunity to be of service.
1
I
- Certificate of OccUpancy
r
Ilvaoeo>Hsn
1�
5
i
OFT9 Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of -the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
t
construction and/or use.
BUILDING ADDRESS: 53-320 EISENHOWER DRIVE
E
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0309-092
k
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RC
Owner of Building: JAMES C. BELKNAP, JR. Address: 73-300 FIDDLENECK LANE
City, ST, ZIP: PALM DESERT, CA 92261
By: KIRK KIRKLAND
Date: March 30, 2004
Building Official
1-
POST IN A CONSPICUOUS PLACE