9804-032 (SFD)LICENSED CONTRACTOR DECLARATION
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
U'b t13�1� fi ,• X , .. gn-1.N$
.Signature of Contractor
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:
ave and will maintain a certificate of consent to self -insure for workers'
ddFhpensation, 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 Policy No.
STATE F IKIJ
uation
(This section need not be completed if the permit valis 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: 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, indemnity
& hold harmless the City of La Quir.ra, 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,paYposes.
Ignature (Owner/Agent) f� �``- '`� Date
/
BUILDING PERMIT PERMIT# CO
DATE VALUATION LOT 9804-032 TRACT 7656
t �3I3,S1l1.20
JOB SITE
APN
ADDRESS
54-1599 CHERRY H11A.S4
OWNER
CONTRACTOR / DESIGNER / ENGINEER
14I1NIS'rRELLI.PAINUD C 0VE, INC'..
M]NISTRELLI-PAINTEL7 UWE, INC'
504451�1tjiUNT.AIN SRADOWS RD
50=4415 ftK)UNTAIN' SHAL'►OWS RL7
Ltd. QU[NTA CA 92253
LA QURIR'A CA 97"53
;'ailtj5C►4:184
r
USE OF PERMIT
S—
PEP- PERWT IJO)ES NOT INt�I,i.FD L0 Y kVA1JLS t.a�PC.kA PAID
AY 141998
�: US`1'OPA CONSTRUI "PNON ;.&10.00 3F
Nt:►- L
CCHIPATIO ?24 AO Sr• A
LN
;' q
GARAG" F-'Cj%RP-0RT 610.00 8r, �
OF
q
'
E.9'I'IM.ATE D COST Ole CC NSTRUCT101V
.l.l ti,-f1l.1.2t!
PERMIT FEE S1•CiNLMARV
CO1�iS ucrit+f31'PE 101-000-419-000 51, 9g.3�i
PLAN C 1EC'K FEF 101 -4100 -X13:► -318 %1, 1:17.813
FEE DEPOSIT 101-000-X139-318
111ECHAXIC AL FEE 10 f -t100-X121-000 S 13' 00
ELECTRICAL FT1, 101.000-42.0-000 5219.16
PLUNISIN10 FEE 101-000-•41 �►-000 � �44_K,
STRONG MC'1'Iot4 FM- - RESID 101-000-1.41-000 1-41. 4
GRADIN(i f'e:1 141-000-423-000 S2ta.Uu
INF"1tASTt�'U('IURE FEE '_'25-000-443-:142 sfi o`illo)
:MKT IN PUBLIC PL,MC'ES - RE•SI. 701-000-255-000 x538-50
SUB=1VYI'AL C`0Nq'ZUC;TION ,AND PLAN CHECK
LESS PRI; -PAID I ; I' '
V!5L'.40
TOTAL PERMIT FEES DUE NOW
$9,484.07
RECEIPT
DATE
G111r
BY
DATE FINALED
INSPECTOR_
NTROL#
USIPECTM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BULDNG APPROVALS
MECHAMCAL APPROVALS
Set Backs p
Underground Ducts
00
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
Framing
F.A.U.
Compressor
Insulation to
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
gC,eQbP,
Final
Final
BLL.®CKWAL.LL, APPROVALS
POOL S o Spas
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMENG APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
D.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELL ECTMCAL 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 .. ,
Maul
Utility Notice (Perm) LO.�
COMMENTS:
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045
REGISTERED INSPECTOR'S' WEEKLY REPORT
TYPE OF
'INSPECTION
PERFORMED
O REINFORCED CONCRETE
O POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
O STRUCT. STEEL ASSEMBLY
O ASPHALT
O FIRE PROOFING
O
O OTHER`
JOB LOCATION
SS' Sy O 611 N. ` ` O
LAG o , �T&
REPORT SEQUENCE NO.
TVP OF�TRVCTURE�/ I, t
JC V 1
PERMIT NO.
q�E�
DAY'OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR
HRS: CHARGED
ENGINEER J
ASSISTANTS
HRS. CHARGED
DATEE�
GENERAL
CONTRACTOR f" % N CS TZ e � 1
OONTION R SUB
LSER U=z--)
3
(a i f j"*.jA C
LQAW�1p
i � dUji
(o'' 1 �
I I n( ALtId UJ
�
61M.
Ail S(N^ oi-4 a1c
COPY SENT TO CLIENT ❑
CONTINUED, ON NEM PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 1 HAVE INSPECTED TQ THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
,*�� 1;-V�, 1 ATUR REGISTERED
INJCTO
7 V X?- Y, 67 Z -??
DATE OF REPORT REGISTER NUMBER
JUL- 8-98 WED 10:17 ESI FME INC
F
M
E S I
FAX N0. 7142618506
ESI/FME, Inc..
STRUCTURAL ENGINEERS
P. 02
Shoot ev--/
Dasa -9
JN. CI I/
FIELD FxFOR MISSING DCrE4110R HOLDOWN .
tmoNOumc PQUFo
4x POST MIN..
SEE FLAN FOR HOLDOWtf—___
CALL OUT
' CONC. SLAB
AO
THREADEDROD
EMBED W/ SIMPSON
"SET EPDXY-TIL* W/
SPECIAL INSPECTION`
INSTALL IN Aoco kNCE wrrH'SWSON STRONG -TIE FIECCMIVIENDATICM
SPECIAL INSPEC IMN. REQUIRED;
LA RR# ?x279. ICBO# ER•-SV9.o.
SIMPSON
HOLDOWN
DIAMETER OF
THREADED ROD
W/ "SET" EPDXY 11E
EMBEDMENT
DEPTH INTO
FIRST POUR
HOLDOWN
FASTENERS
INTO POST
HTT16
518 INCHES
10 INCHES
(1.8) - T6d's.
MTT28B
5/8 INCHES
10 INCHES
(24) -16d's
HTT22
618 INCHES
10 INCHES
(82) -16d's
HD2A
518 INCHES
10 INCHES
(2)- 5181dia bolts
HDSA
818 INCHES
10 INCHES
(2)- aledle bob
HD6A
718 INCHES
10 INCHES
(2) - 71811 dia bolts
HDBA
7/a INCHES
f 10 INCHES
3 -- 7!8" dla bolts
ESI/FME, Inc.
STRUCTURAL ENGINEERS & CONSULTANTS
July 29th, 1998
MINISTRELLI CONSTRUCTION CO.
50-445 Mountain Shadow
La Quinta, CA 92253
ATTN: Mr. Brian Huffman
RE: Field Observations on "Holm Residence" PGA WEST - LOT 25 to
be built in La Quinta for MINISTRELLI CONSTRUCTION CO. (ESI/FME 398-W11
BBG 124-0612)
Dear Mr. Brian:
Based on our field observation on July .3, 1998 and July 29, 1998, the building appears to
be in general comformance with the construction documents and/ or the structural design
intent. These field observations does not waive the responsibility for inspections per 1994
1994 UBC Section 108, 1701 or other section of the UBC.
This letter is not a guarantee nor a warranty expressed or implied.
Thank you for,your attention to this matter. Please do not hesitate to contact us if we can be
of further assistance to you on this project._
Sincerely,
ESI/FME,
By: �Qo �,�Ar
IN
Danny
1921 E. CARNEGIE,AVE., UNIT 3-J, SANTA ANA, CA 92705 • Ph. (949) 261-1811 / FAX (949) 261-8506
ESI/FAME, Inc.
STRUCTURAL - ENGINEERS & CONSULTANTS
PROJECT SUMMARY
SITE Single Family house is situated in a developed area.
Field Observation on July 3rd, 1,998 with Ray [John Beard Construction]
and Brian Huffman with Ministrelli
FIELD OBSERVATION.
Thefollowing structural items were observed and need to be addressed:
For location and clarification of items, refer to photo reduction of framing
plan on following sheet.
ITEM
General
Provide 1/2" dia threaded rod Simpson SET Epoxy be embedded 41/4" into first pour
for missing anchor bolts per ICBO#ER-5279 . If slab and footing are poured monothically
embed threaded rod 4114".
2 Check all headers for solid bearing on trimmers.
Garage and Service Room:
a2 0L- Shear -wall in Front of'Garage: plywood shear nail across garage door header over
shear wall.
d4 Garage side door:, Provide Simpson A35F on each side of header to king stud due to
floating trimmer.
BEDROOM 02, BEDROOM #3, AND FAMILY ROOM
<:� "hear wall btwn Family Rm & BA#3: shear nail plywood to post with holdown
Nook and Kitchen
50 V Right side of 'Nook: Add Simpson CS16 strap At top plate height change per'Detail
O/SD2.
6 OIL- Rear of Nook: provide Simpson CS 16 strap along side of drag truss, and to wall at rear
of Dining Room per Detail Q/SD2.
1921 E. CARNEGIE AVE., UNIT 3-J, SANTA ANA, CA 92705 • Ph. (949) 261-1811 / FAX (949) 261-8506
FIELD
REPORT
SITE VISIT NO.: ONE
DATE
July 9,1998
PROJECT NO
398-8441
PROJECT:
Holm Residence, - PLAN 1, LOT
25 CLIENT NO,.-
BBG
BUILDER
MINISTRELLI CONSTRUCTION
FILE NO
FR1
LOCATION:
La Quinta, California
SHEET NO :
1 OF 3
ARCHITECT:
BBG ARCHITECTS
ATTENTION:
Brian with Ministrelll
PROJECT SUMMARY
SITE Single Family house is situated in a developed area.
Field Observation on July 3rd, 1,998 with Ray [John Beard Construction]
and Brian Huffman with Ministrelli
FIELD OBSERVATION.
Thefollowing structural items were observed and need to be addressed:
For location and clarification of items, refer to photo reduction of framing
plan on following sheet.
ITEM
General
Provide 1/2" dia threaded rod Simpson SET Epoxy be embedded 41/4" into first pour
for missing anchor bolts per ICBO#ER-5279 . If slab and footing are poured monothically
embed threaded rod 4114".
2 Check all headers for solid bearing on trimmers.
Garage and Service Room:
a2 0L- Shear -wall in Front of'Garage: plywood shear nail across garage door header over
shear wall.
d4 Garage side door:, Provide Simpson A35F on each side of header to king stud due to
floating trimmer.
BEDROOM 02, BEDROOM #3, AND FAMILY ROOM
<:� "hear wall btwn Family Rm & BA#3: shear nail plywood to post with holdown
Nook and Kitchen
50 V Right side of 'Nook: Add Simpson CS16 strap At top plate height change per'Detail
O/SD2.
6 OIL- Rear of Nook: provide Simpson CS 16 strap along side of drag truss, and to wall at rear
of Dining Room per Detail Q/SD2.
1921 E. CARNEGIE AVE., UNIT 3-J, SANTA ANA, CA 92705 • Ph. (949) 261-1811 / FAX (949) 261-8506
er;
ESI/FIVIE, Inc.
STRUCTURAL ENGINEERS & CONSULTANTS
FIELD OBSERVATION: "Holm Residence PLAN 1, Lot 25 Date: July 9,1998
MINISTRELLI CONSTRUCTION ESI/FME J.N. 398-8441
Sheet No.: 2
Nook and Kitchen
7o1- Shear wall.at rear°left side of Nook: Provide 1/2" dia. threaded rod due to missing
anchor bolts. Refer to item #1.
Dining Room,Entry and Living Room
8_gi Shear wall at Right side of Dining Room: Provide Simpson CS16 strap from 4x10 beam
to blocking between studs over shearwall. strap to be a minimum of 4 ft..
Shear nail plywood to blocking at upper roof for shear transfer from upper
roof to shearwall.
9 0 yL' Shear wall in. Front of ' Entry: Referto item #1 for missing anchor bolts.
100— Between Dining Room & Family Room: provide OS16 strap to plywood shear blocking
and wall in front of Entry: per Detail V1/SD3.
11 e V__ Provide horizontal plywood 911 to tie wall at. right side of entry into drag truss over
Dining Room.
12 • L4- Shear wall at left side of Living Room: Provide Simpson A35's @ 8" per Detail
H/SD2 and providel fix for missing anchor bolts. See .Item #1.
13 0� Shear wall at rear. of Living Room and Dining Room: Provide fix to Simp,son HTT22
per fax sent 7/7/98. Provide drypack, under column base. j
i
Masterbedroom & Masterbath
140- Rear of Powder Room: Provide fix for missing M717288
1 Provide Simpson CS16 strap (4ft long equally spaced) from truss over lower -roof to
double top plates over6x12 beam in front of MBR in lieu of. Detail N/SD2
16 X-Rearof MBA: Provide Simpson CS16 strap due to change in top plate heights.
Provide fix for HTT22.
DISCLAIMER: THIS WASA WALK-THRU�F EVIEW: WE DID NOT INSPECT THIS
BUILDING. OUROBSERVATION WAS ONLY FOR OBVIOUS PLAN OMISSION. A.
DETAILED. AND COMPLETE REVIEW WAS NOT PERFORMED:
ISSUED BY:
ESI, / FME, 'IN
oFt=ss/
COPIES TO:�
STRUCTU
(3)
MINSTRELLICONSTRUCTION
BY.
�� `�=
(fax)
Attn: Brian Huffman
C_
(1)
BBG ARCHITECTS
Attn: Anton Marinkovich
Dan y Ma
OF GA1.\F
1 21 E.
E.,
UNIT 3-J, 'SANTA ANA, :CA 92706
Ph. (949) 261-1811 / FAX (949).261-8506
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PGA WEST
RESIDENTIAL ASSOCIATION, INC.
PGA WEST RESIDENTIAL ASSOCIATION, INC.
Notice of Architectural Approval
This shall serve as written notification to the City of La Quinta that Mr. and Mrs. Holm. of 55-590
Cherry Hills has gained written approval from the PGA West Residential Association, Inc.
Architectural Committee and from a Management Employee of the Homeowner Association.
Specifically, Mr. and Mrs. Holm has the approval to proceed with the construction of a custom
home. This signed approval must precede the issuance of permits from the City of La Quinta.
Architectural C mmitte
HOA Management
T(17
Date
Date
P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125
0
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
April 9, 1998
Donald & Karen Holm.
Dear Mr. and. Mrs. Holm:
Your request for an architectural variance has been approved by Mr. Don .Adolph, Architectural
Committee Chairperson. Specifically, you have the approval to proceed with the construction of a
custom home on your 55-590 Cherry Hills lot. Upon completion, please submit the Notice of
Completion form to our office.
The signed PGA West Residential Association, Inc. Notice of Architectural Approval form must be
submitted to the City of La Quinta prior to their issuance of permits.
We reserve the right to make a .final inspection of this change to make sure that it matches the
original request. An approval is based only on the aesthetics of your proposed plan and should not
be taken as any certification as to the construction worthiness or'structural integrity of the proposed
change.
We appreciate your cooperation in submitting this request for approval. Should you have any further
questions regarding this matter, please feel free to contact me at the HOA office, (760) 771-1234.
Sincerely,
Michael L. Wa ker
General Manager
cc: Architectural Committee
enclosure (1)
P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125
105212
17423
OLD NPUsuc nTLE CQ
DED MAIL TO:
If,� DONALD HOLM
is"KARb HOLM
025557
RECEI /fT A�OpAM
PAID JAN $ 0 1999
Obc.11attAfer Rost ���
geootdpr 141011,
hM
D MUI DITAW TPM,* -Lm W f.., 1.73 ..25... WRU% 0e9n rwle LINE PW MUMPOWUSE
..... t7B e1e E011lIdllYa-p W V81400t wup"'ootMletipd OR
.W...cen,ptded on on p miftrsif>w W van leas liana or elmm6remn THE UNMRSIGNO GRANTOR
GRANT DEED
A VALUAf1Ll: CONSIDERATION, receipt of wW .h Is hereby wArKwotedged,
TWO LAKES JOINT VENTURE., AN ILLINOIS GENERAL PARTNERSHIP
GRANT(S) to DONALD J. HOLM AND KAREN HOLM
husband and, wife an joint tenants.
meld prop" In dmCny of LA QUINTA
my of RIVERSIDE, $me of C� ��� a
IAT 25 ft TRACT 25397 IN THE CITY OF LA QUINTA. COMM Op RIYi:RSIDE, STATE OF
CALMRNIA AS PER MAP RECORDED IN BOOK 219, PAGES 20 THROUGH 25, INCLUSIVE OF
MAPS, IN THE OFFICE OF THE COU'TNT RECORDER OF SAID COUNTY.
APN A 769-620-025
JANUAT 12. 1998
bOm rhe.
' ftno.n to me W po"d to fnq on the bass of ffflf k t toey
! �^_rm�11/Ieilatefr+becnbe0h/MMMfM11
j; ttrldanEa fOlted�e Ww110ee
lr. awtrlottent and P -at he►atm oy e'amftd 1+e tam
004nm to w"". and that by 1u6ftermW ftod•
f+va1N fxt the ugatmlttln the pfft "40 a one erttltyi ton beast of wach
`.III ate Itersoflbl eded em wed go uteaun m
� ' VdTNbSl; ftttatt lt.+o ofnvea t�
fl; I 1 ftr4dwtf &00
MAIL TAX STATEMENTS TO
ZOO •d
TIDO LAXES JOINT VWWE
AN ILLINOIS GENERAL PARTNESHIP
BY-]",, �"
'THOPO^^ARRS RDSENQUI5T
C�
MAR'I'NA ROS60IiST
rsao�e
"0RPICtAc Sfs/1r."
IT
ishy /ISO Ildf� bf auttoule
M,eatn�bn'!b 1"ltimn a W
9z:01 1aaW eb ,d-10
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot, Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/4/98
No. 16974
Owner NameMinistrelli Construction
APN # 769-620-025
Jurisdiction La Quinta
No. 55-590 Street Cherry Hill's
City La Quinta zip 92253
Tract:#
Lot # ,?S 1"
Type of Development Single Family Residence
Comments
Permit #
Log ,#
Study Area
Square Footage 3.840
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
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
1.93 X 3,840 or S 7,411.20 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 Community Bank / Ministrelli Telephone
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected,/exempted by Olivia Aguirre Payment Received $7,411.20
Check No. 078563
Signature
NOTICE: Pursuant dt Assembly Bill 9081 (CHAP,549, STATS. 1996) this will serve to notify you that the 904ay approval period in which you may protest the lees or other payment identified
above will begin to run from the date on which the building or installation penin for this project is sssued for on,which they are paid to the District(s) or to another, public entity authorized to
collect them on the'District('s)(e') behalf, whichever Is earlier:
Collector: Attach a copy of county or city -plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting