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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
Cil
ate 1 I 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:
( ) 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.
( 1 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.
�
'TACA x"r, .'L• f:if. C;t;'t23
(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. ,
Bate: I 4 h Applicant ' t r c•+,. i^
/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 forr,inspection purposes. '
Vdignature (Own er/Agent)/J^%�M- �'-� Date
BUILDING PERMIT
PERMIT"
1cw
DATE oig/mi"VALUATION • LOT
TRACT
JOB SITE
ADDRESS 79 025 BIG ti)M 71RML
APN ''605,51D.oft
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A Y i_ l IR 1r
.t1htS'47tF[.1., 1 t!„1'i'E:l?CO , S;,1NC.
N. P R C 1 hl
.,IIrftS#i�.3;1.1✓�-E�.i„IiD..:�'i i;, T..C.
74785 HWY I I I titti 105
747K5 HWY 1t 1,'71M 105
{N(1fAN"!1(, 1, US CA 92210
IN MAN W1,1A S CA
922113
(70)MC-4450 CBT1#
USE OF PERMIT
OEWR Ai. L�U�f.i31NCi
2413 L.F. X,5 ALOCK vJAU. (ORC6 i'ST'EM)
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PERM iT FEC SUMMARY
C(*lSTKQ.t(."i')rJN D' &T, 10 1 4A)A 18 -OW Str1.0
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1. 1 -'MT AT, C;'tWrrrlAMON ANT.) PIAN ClI CK.•-
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{{�
r ` A / FEE'S
$0.00
U1•'d'M,1.=ERMIT YCES O iE NO'1+1►
sa1.00
i
RECEIPT
DATE
BY /
DTE FI ALED
INSPECTOR
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.K. to Wrap
F.A.U.'
Framing
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 Hacks
Electric Bond
Footings
_
Main Drain
Bond Beam
Approval to Cover
_
Equipment Location
Underground Electric
Final
-�p
Underground Plbg. Test
Gas Piping
PLUMBING AP ROVALS
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)
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 4/20/99
No. 18601
Owner NameMinistrelli-Painted Cove, Inc.
No. 79-025 Street Bighorn Trail
City La Quinta
Tract # 25429
Lot # 13
Type of Development SFR Mitigation
Comments
APN # 769-550-006
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area
Square Footage 1
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:
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 a 4lat,building
permits and/or Certificates of Occupancy for this square footage in this proposed projec6m4y now be issued
Fees Paid By CC/1st Community Bank/Kevin Peters lelephone�'*r776=' 450
Name on the check f '_
B Dr. Doris Wilson��
By �.
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $628.00
Check No. 085735
NOTICE: Pursuant of Ass4/nbly Bill 3081 (CHAP 549, STATS. 1996) this will 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
tolled them on the District('s)(s') 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
Dear Builder:
T4ht 4 4 Q"
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
Prior to issuance of a building permit, you will be required to obtain clearance from the
Public Works Department for one, or more, of the following:
1. Verification that rough grading is complete, and the pad elevation certifications
prepared by a licensed surveyor, or engineer, are on file in the Public Works
Department.
2. Verification that infrastructure improvements and other required tract improvements
are complete, or sufficiently advanced to warrant building permit issuance.
3. Prepare an engineered grading plan that provides for on -lot storm water retention,
and have it checked and approved by the Public Works Department.
• Tract 26524 (Estancias)
• Tract 26769 (Mountain View Estates)
4. Prepare an engineered grading plan that provides for building pad grading in
accordance with the existing soils report and tract grading plan, and have it
checked and approved by the Public Works Department.
• Tract 28034 (South Valley Estates)
FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT
TRACT: 1662/ 1
LOT-
I
PUB 1 WORK AUTH R ZATION I I 15ATE
F:\PWDEPTIDOCSIFORMSIPW CLEARANCE LETTER.ss
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YOUNG ENGINEERING SERVICES
47-159 Youngs Lane, Indio, Ca. 92201 (760) 342-9214 fax (760) 342-6164
April 19, 1999
Tom Hartung
Building Official
City of La Quinta
Re: Lot 13 Painted Cove - Truss Review
Dear Tom,
We have reviewed the truss submittal package prepared by Spates Fabricators for the above referenced
project and have found it to be in substantial conformance with our structural plans.
If you have any questions or concerns please call.
Young S.E.