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SFD (14902)• P.O. BOX 1504 No. 14902 Building78-495 CALLE TAMPICO 50��32��• Address Shadows LA QUINTA, CALIFORNIA 92253 """r"r J. Peter Hinistrell{ Address 50--445 Mountain Shadows City Zip Tel. La Quinta, CA ..9225 554-1849 Contractor. Mihir�trell{ Construction Sarre i ty State Lic. City & Classif. g 691899 Lic. # 3625 Arch.; Engr., 'Designer Stanford — Leonard Address Tel. 740-55 Hwy 111 1 - 776-8478 City Zip State Pal Bepe.;Vt-, 1 92260 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.•Business4ag rofes'sions Code, and my license is in full force and effect.•,'- SIGNATURE ftp" — --" ` "w 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 Coder 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 file a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 civilpenally o1 not more than Ove hundred dollars ($500). 0 .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 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 or 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 torr strucl 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.) ❑ 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. ---.Company O 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, I shall not. . employ'pperson in any manner so as to become subject to'the Workers' Compensation Laws of California. Date _ Owner NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become subject to TO. 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 ($100,000); IN ADDITION TO THE.COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. • : _ I certify that I have read this application and state that the aboveinformation is correct. I agree to comply with all city and county ordinances'and state laws relating. to building construction, and hereby authorize representatives -of. this city to *enter the above-- mentioned property for Inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING: TYPE CONST. • -N •. 'OCC. GRP. SR A.P. Number 76$^55.0-401 Legal Description Lot .6 Tract 25429 Project Description SF D ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Ce/ "_ ine Side Setback from Prope / e FINAL DATE INSP Issued by: Date 9PpeAit `0 Validated by: f Validation: `s Sq. Ft. No. No. Dw. Size • 2964•_ . Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Permit does not include: block 4walls or. pooi . Estimated Valuation'. $182,4017*00 PERMIT AMOUNT Plan Chk. Dep. 250.010 Plan Chk. Bal. 534.91 'Const. 930.00 Mech. 86 . 0101 Electrical 230.32 Plumbing 169.50 S.M.I. 18.24 Grading -20.00 Driveway Enc. .00 Infrastructure 3o986.86 ..Arts in -Public Places 206.02 irts in Public Places credit (20.02) TOTAL 6,226.83 5,975.83 REMARKS Arts in Public . Places credit mer ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Ce/ "_ ine Side Setback from Prope / e FINAL DATE INSP Issued by: Date 9PpeAit `0 Validated by: f Validation: `s CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINi FEES 1ST FL. SO. FT. ® $ UNITS LAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SD. FT. OUGH) /,� O V ` DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation J INAL INSP./6 2? 666 FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER RAMING �� GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 3 Olt - �l`. TV L'V ��I O ^�� yi (G� )) LAUNDRYTRAY AIR HANDLING UNIT CFM VENTILATION 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1 Va c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK D PLUMBING L UNDERGROUND A.C. UNIT COLL. AREA LAB GRADE PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS OR SEPTIC T/ SR ool ROUGH WIRING DUCT WORK ROCKSTORAGE UND. REINF. OUGH) /,� O V ` METER LOOP HEATING (FINAL) OTHER APPJEOUIP. P,EINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE J INAL INSP./6 2? 666 BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _ $ LUMBER GR. 4eUIJAL INSP&Y--I� RAMING �� FINAL INS�v1 �) , ROOFING 3 Olt - �l`. TV L'V ��I O ^�� yi (G� )) REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING MESH INSULATION/SOON FINISH GRADING FINAL INSPECTION`�� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL i . r z DESERT SANDS UNIFIED. SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 2/27/95 Type of Permit I La Quinta No. 13318 Permit # Log - Owner Name J. Peter Ministrelli No. 50-325 Street Mountain Shadows city La Quinta Zip 92253 Study Area 125 APN•#, Tract #' Lot # 0 Square Footage 1 Type of Development Single Family Residence No. of units 1� Comments 't 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:' ' Under Mitigation Agreement > ` EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to - Government Code 53080 in the amount of. 628.00 x or $ 628.00 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' Ministrelli - Painted Cove, Inc. Telephone 564-1849 Name on the check By. Dolores A. Ballesteros Superintendent j y$ 77 Y P .4 `•�+' T Fee collected /exempted by Pauline Pearson1 "- Payment Received`' f^ F Signature A o (1 r �kAA LVV\_ ''Gi1PC�ia�6yo. 1455 Collector: Attach a copy of county or city plan check application form to district copy for allwaivers. Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting ii; . .- � _ ... r _ � _ _