SFD (0002-234)LICENSED CONTRACTOR DECLARATION
0preby affirrn under penalty of perjury that I am licensed under provisions of
Chapter 9`(commencing with Section 7000) of Division 3 of the Business and
,; Profess onals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
6,93899 B WC✓ / jf /r 1/2(
ate + Signature of Contractor a =''�' % -k
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 fol lowing !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.
X) 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:
Carver. STATE I+tf`HD Policy No' 046-00-0006S►13
(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 -(,.should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those• provisions. y%r
Date: 2- 1 Applicant "A �� L� _ � ��+•
Warning: Failure to secure Workers' C/ pensation 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 condition's 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
e above-mentioned property or"inspection_ purposes.
f r /4 �r
Signature (Owner/Agent) _ Date r�I
BUILDING PERMIT PERMIT# .
13002--234
DATE � VALUATION LOT TRACT
1 ` $2A4,".y 1.,10 11 25429
JOB SITE
ADDRESS 50-4455 Mf7ITN',1'AW R=O WS
APN
769-550-W4
OWNER * ; :
CONTRACTOR / DESIGNER / EN (NEER
1"10MUU,T-I?.A:1Jt '.T.M COW., INC.
:i�IW&RYJ.U,--PAil`l , "E0 COVE, TQC.
74785 HWY 111 STR 105
74785 HWY '1 I 1 ' 105
DWLkWWELL9 CA 92210
IMIM C.B I.V19 f.` CA 92210
'
(760)776--4450 CRIX 3625
USE OF PERMIT
wiA GLr,,FAMMYDVM NG
3FO- PEW11T DOES NOTrINCI UDE BLOCK WALLS OR POOL.
3
TRADT C04STRUCTION :k,607,00 SF
PORCH/PATIO 314:00 SF
s
GARA.0fiCARPORT .(OF) 14,464.80
'r
lf:Y%i1VlAI COSI' OF COnyIBluc.i71(aw
214,5£01,10
MACTFUMMMARY
CONSTRUCTIO14 FEE 101"000-418-000 S1,0Q,00
PLAN CHECK FEE 101=()(10-4.:39-318 $898.16
f ER DEPOSIT 101.000-439-318 4250100
MECHANICAL F92. 101-000-421.000 $130.50
ELECTRIC oNI, FEE 101.000.4%05000 51 9.51
PLUMBINO FEE, 101-000-419.000 $30.50
STR( NO MOTION RE -.RI::+;IIS 1,01-000-241-000 $21,45
O ADINGg FEE .` . . 101-000-423-000 $30:00
DEVELOPER IMPACT FEE ' `� -, $1,907.00
. 1.
ART'CN PUBLIC P1_ACES.-R.ESIE701-000-2SS-000
(1'(.JR-TO AL C0kWMIR"'7.TON AVM PTW CRECK
x,537.37
I':e & e3 PPX-PAW F.fWS
-$250,00
TOTAL a KEW. H'�'u S IATA NOW
54,2137,37 '
4
RECEIPT
DATE
BY
.
DATE FINALED
INSPECTOR
r
C-
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
Q
Exhaust Fans
O.K to Wrap
_
F.A.U.
Framing
Compressor
Insulation
en
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lathf
_
Final / _
BLOCKWAL A ROVALS
Final
POOL - PAS
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
L✓ E%`
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
Final
Utility Notice (Perm)
COMMENTS:
}
P.O. BOX 1504
Building�6"7 p 78-495 CALLE TAMPICO
Address 4 J u!%xrgj iN \ J{{R�(j(,� 1 A. LA QUINTA, CALIFORNIA 92253
Owner_ A
Mailing ��1� 1
Address r111A, .!Joi
CityIp Tel. I
Contractor A.#
/All -:57"FE!
Address
ity (Zip ITel.
State Ljc.�
8 Classif.
(, g -t q
City
Lic. #
I
Arch., Engr.,
Designer
Address
I Tel.
City( Zip ( State I
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, atter, improve, demolish, or repair any structure, prior to its Issuance also
requires the applicant for such permit to fila 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 the alleged exemption. Any violation of Section 7031.5 by 'any applicant for Opermit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
1.2 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, Butsness 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
orimprovement is sold within oneiyear of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
F1 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.)
17 I am exempt undei Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION' t
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
WorkeCs.Compensation Insurance, or a certified copy thereof. (Sec. 3800; Labor Code.)
.Policy No. Company t
n Copy is filed with the city. ❑ Certified copy is hereby furnished. a
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This -section need not be completed ifthe permit is for one hundred dollars (5100) valuation
or less.) -
I certify. that in theperformance of Ing 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: 11, 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 -of this city to enter the above-
men
bove•
mentioned property for inspection purposes.
Signature of adplicant ----Date-
Mailing
ateMailing Address
City, State, Zip
APPLICATION ONLY
ILDING: TYPEE'�CCONST. �r OCC. GRP.
m(�
' Nu
ber 6 65666,y
)al Description l % 7-11•
eject Description %
Sq. Ft.
Size
New ❑
No. No. Dw:
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated valuation
PERMIT AMOUNT*
Plan Chk. Dep.
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
Side Street Setback 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
Desert Sands Unified School District
•� rr 47-950 Dune Palms Road
Notice: - La Quinta, CA 92253 "
Document Cannot Be Duplicated 760-.771-8515 y
CERTIFICATE OF COMPLIANCE ;
Date 2/24/00 APN # Not Available
No. 20064 Jurisdiction La Quinta ' -
owner NameMinistrelli - Painted Cove,=Inc. Permit #0002-234
,
No. 501445 Street Mountain Shadows Log #
City L•a'Quinta zip 92253 ' Study Area
' Tract # Lot # 11, a Square Footage, A.
•
Type of Development SFR Mitigation No. of Units'. I
Comments Single Family Dwelling @3,444 sq. ft.
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 Mitigation Agreement , in the amount of
628.00 X ` 1 or $ 628.00 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/First CommunityBank/Kevin. �t
Telephone ;760-'7.76-44-% • i
Name on the check x Z'!
By Dr. Doris Wilson
Superintendent +, ry; y'',,
Fee collected /exempted by Mary Ann L. Bora • ' Payment. Received
362K,00,;;Check No. 091739 x ,,
Signature
F
CE: Pursuant of Assemb ill 3081 (CHAP 549, STATS. 1996)thiswill serve to notify you that the 90 -day approval period in which you may protest the fees orotherpayment identifiedeill begin to run from the date on which the building or installation permit for this project is sssued or on which they ere paid to the Distdct(s) or to another public entity authorized to
ct them on the Distdct('s)(s') behalf, whichever is earlier.
s -
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt " Copy.- Accounting