9712-095 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H . -Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V W Professionals Code, and my License is in full force and effect.
=) ch License # Lic. Class Exp. Date
LU
o Z /ate - X �� Signature of Contractor !�V
0Qr",
J (-) m OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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
N Date Signature of Owner
QCV
C)
a- Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
LIDH Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X UJ 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
�Q U Section 3700 of the Labor Code, for the performance of the work for which .this
CL rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
r 19t Z Carrier Policy No.
ob O "".1"AI V VI D 046`' t1�1f1f,°,r2 t
J (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
P"Ode, I shall forthwith comply with those provisions)
Date: n• Applicant 1� %k'.•
�` -
Warning: Failure to secure Workefs' 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
A . 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
mth ,above-mentioned property for inspection,.purposes.
ature (Owner/Agent) �
PERMIT # CONTROL #
BUILDING PERMIT
DATE VALUATION 2x2,%si. �(� LOT n TRACT..��,�
ADDRE S + %��-dl AI.€Csi3.ORI I+I TiLU
APNJOB
OWNER
CONTRACTOR / DESIGNER ENGINEER
tt[ 1 p f T Y t1 A t1 i (i�p��`ii.iif�i i'Ay,IJi.I,. F. -C [1ff"-itGt_r .
COVU,AIC.
N-1 III"!MIR n1}Q.�wc.
50,145 hlOL)NITAIIt1,SHAD(AVS K0
50445 NK)UNM%IN SHATX)NNIN 11.0
i.r1> Ql.lit` TA CA 9225:
1,F1(; UINTA CA 92113
CRTIA MIM
USE OF PERMIT
si.f' t.I
E -FC) - VERNi11' 1OE5 NOT s"IJ::`i3Oi: R UCCK Wf U'Po OR :FCXi L.P T 114
,I✓)1BLIC; F11,AC i:S Clti`:'MT O $N6,97 PEER AMEFN1iS1141.` W/ CONfmi . DEV. PAID
JAN 0 8 1998
I iZACIT C-0N43,r ,UC7�'.ti 4 _S� rtH3.0O S1
1't J- Cf•ff"v,xvfo 456.00 5r
l
' +..o��aiEi.e°��� n!.�✓ w +�".k'�+� �ii1 �,.�i���'3�� is.��ii�`� �i,%!v
.�nro N: n«
C'ONSTIZc1C4l.1(JN I -r,0 101-000-411Y.4XV $1.07+10)
PLAN 0TI ` i IFF $i)705,t)7
1#'ilsi.f3ai1+114'.b'1, f Ii1i 101 -MG -421-000 $143.0)
101-t?(it)-420-000 $744. iS
1114.1NtnIw-j F•f. $,2505 50
3111,10NO NtO',C.It7i41 FELL • I1EEST1? 101-OUO.1 .0W
of.M)1140 FEE 000)
t ilFFt�1,9T.tt Yt 'fU.1t1? 2r},r : 225-W1-443-342 $ri,ftTS t�1-
T)y r(vlltil 131..n,N ) f)) -000-d-4-145 $23 Oil
APLIV IN 1'031,1.10 VLAC?S - 3tI': S(T; 701-000-X55.000 $306.97
AWP IM Pt1M1Cr PLA(T..3 - .12 ID 701-000.2 5-000
SSU: _40171A_T, COM10`KUCTION ANT),PLAN CHECK
1. "ES S PRY -x A11) E!3
4556 17
`I t3' AJ.PE"I Y" FE)EN DUR, NOW
$7,332.47
RECEIPT
DATE
BY
INSPECTOR
I
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 7
Underground Ducts
Forms & Footings l _�_ L�
Ducts
_
Slab Grade /. �G
Return Air
_
Steel
Combustion Air
Roof Deck Ll _ _
O.KtoWrap
Exhaust Fans�g
F.A.U.
L6G-
Framing 3�EA3-114e,—
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 -- �
POOL_ S` -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines Q
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
'O.K. for Finish Plaster
ewer .ateral IdaPool
Cover
S onnection b
Encapsulation
Gas Piping
Gas Test _
Appliances
Final
COMMENTS:
Final f7
Utility Notice (Gas) U '
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
_
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
' Sub Panels
I Exterior Receptacles
! G.F.I.
_
Smoke Detectors
I Temp. Use of Power
� r
Final
E Utility Notice (Perm)
l
Building 1 iQ
Address 1
• Z�Q"
P.O. BOX 1504
78-495 CALLE TAMPICO
'el '7pA1, LA QUINTA, CALIFORNIA 92253
Owner/111�/}
� 1AI1S—/,Ra![/ 0/US7Jtj/Co,J
Mailing ,/f (�
Address SO,4, j 5 /v VAJrAIN Sim bow's RN
City`1 Zip Tel.
1,4 G)tl, AJ7-A 1
Contractor
Zip
State Lic. I Licy#
8 Classif. l 3 �' A i s
Arch., Engr.,
Designer '-I L C'w'REA
Address I Tel.
CityI Zip I State
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, alter. 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 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 thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
I-1 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, 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I 1 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.)
1-1 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
r] Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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 any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, 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
1 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-
mentioned property for inspection purposes.
Signature of a0plicant —Date—
Mailing
ateMailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number '� 6 G 5'<4 f4 a 769 - S5o - oy
Legal Description n -:r 7
Project Description 75 r N
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
Sq. Ft.37 No.
Size 3 Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
'<I ►,{ I L A 9- 79 ' I l l i
C 1 6;9 0 #. T Q 4A le
�SAn�� n�.,.>►a 'f>1tGtcfArc.)-r
rs�.ti►le4-rrr,i�
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
�. /� . OU
Plan Chk. Bal.
Const.
Mech.
t
Electrical
Plumbing
S.M.I.
Grading <t
t
Driveway Enc.
Infrastructure
DEM 1
Ci
Q 1-H NAR
1
TOTAL 1.4
REMARKS
i
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
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 12/30/97 APN # 769-550-021
No. 16457 Jurisdiction La Quinta
Owner NameMinistrelli-Painted Cove, Inc. Permit #
No. 79-100 Street Bighorn Trail
City La Quinta
Log #
Zip 92253 Study Area
Tract # Lot # .2 7 Square Footage 1
Type of Development Single Family Residence No. of Units 1
Comments
sgare teet
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 Mitigation Agreement in the amount of
1.84 X 1 or $ 1.84 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 Cashier's Check/First Community Bank Telephoi8-"564-1849
Name on the check
By Dr. Doris Wilson '
Superintendent '
Fee collected /exempted by Ellen Patino Payment Received $9 28:00 `
Check No. 076073
Signature
40TICE: Pursuant of Assembly 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 Dislricl('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
DEC -30-97 TUE 8:30
f' 1,
CAL WEST ENGINEERING ,E
32-812 Aurora Vista, Cathe&al City, Ca. 92234 (619) 328-8150 (114) 248-5139
, December 30, 1997
Mr Marls Harold
Building Department
City of La Quinta
78-495 Calle Tampico
La Quinta, Ca. 92253
Re: Review of Truss Calculations for Lot 27 Painted Cove, La Quinta
Dear Mr. Harold,
we are writing to inform you that we have reviewed the truss layout and calculations for
the above noted project and have found them to be in general conformance with framing
plans for the project.
Please contact our office if you have any questions regarding this matter.
Sincerely,
Cul West Engineefing, !E
Kurt M. Saxon, P.B.
Principal
P. 02