9710-177 (SFD)rn
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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
-.1119
-/Date U Signature of Contractor's
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 - •Sianature 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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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. '
�I'Ai�irT;,S1) 411.15-:',-fK.Mfi;r„t
(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., -__ _
VDate: 11' '0 `r i Applicant !, . /r h
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.] 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 inspectio6 purposes.
Signature (Owner/Agent) y ; '•'� , Date
BPERMIT# CONTROL#
BUILDING PERMIT
�7li1-177
r
DATE /,/VALUATION2 Z' Tx LOT .� TRACT + 227
�n :p
ZC1
JOB r
ADDRESS 'i itAi1,
APN
769.5.54).0207=%-•iZ1#:i[t..lt'E;RI4
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�srrr:��rt:.t.r•�•I>,�;rrr7=,slCOV;,TNICas.rrr�rfcsr►.r.�.��,ti:�rtt;c�t:OA14:,INC
5113.45 NIOUM AIN SHACAD: 8 R1,)
.'04-15 AICAUM't'AIN'QIA '+C)WS Rt::
i.A QUIMt'A CA y1,!„w5
I.A t ►IAKI'A CA 9412153
t1s�).5ti4.IHlt`.t C,RI.tt ,u;2S
USE OF PERMIT
sfi1.:
SiTr . i'tia2Ati7' in pi's. N+ ► i' f i `i.iat;f; ltl,r..�s4 �i'Ai i. i i pit [,� )0i.. r1RT 413.1
101Jf{LKf VLACI:.,S FEE CRil- AT OF 1:3(* 97 ISSUFJ) PER AI;FCE INTI Ni' W/
C()&fi4lJNJTy f)fiv. I 7.1''1',
TRAC'i '0N:r11:tX71[014
1'4:ittC1111•:T1CG dtitr,tlil Sty
i i/�3tt1<.tll�.:A}11'L�IC'!' fct)•#.tMl S
li.�� fill'. 1�T I ID �IM, (W ON 1 �•�� tCl,�4 P, 'S�
6 4.Y� r4rir,YV
PERMIT FEE SUMIAL%RY
+70N?;TK(!C—I'J0N FFti 10t-1lt}tl-418.M) Si•+i7(1.ltC+
114,AN C1 TfX F-14' 101-(n)-l3k)-31it
NitICI IANf ry AL F}:ii 101-1 M-:121-000 1 Lt:i i to
Ica
E L 147 1RICAL f 4 I01-000-420.OW SV4,58
14111tIVIT1 Nr 0WE Ifl14Y)0-3j�t.W, Si}
C* 2
.+"PRONG Rf(.rt'10t4 I -41C,- RIZID 101-000•'•ti-OW 57.".':3
C.,0 0
CORI [KCI FEE 101-{tt?t"2i-004 42o.4-ri+
�
INI.kA:.`f'kf! f'1JtCR FEL. 225 -OW -1,111-142 $4,873.04
Ptt }-*(• f ,4tl? t+t - A.N
r%t� f .tir i'ir2111,,1 t I.r� 1_41 - iu:.:.0 .101_0*1V-4 ,S•i,' f liJt�l.:•,
ART {N r�t►t�l.itf:1'!•HC} : -411)41 4111: 70i -0t OZ55.OW -'y '•,?iY7
S i%:; -•I( P,At.,f' jN,,�Tjit_(TIt3N1lND1't,Ahtt''tif-CK
$7.F00 44
TOTAL PERt'►iit'1' FERE DUE, N(AV
. y
$7,1.12.47
RECEIPT
DATE
BY
D ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 2
Ducts
Slab Grade —
Return Air
_
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing LCompressor
Insulation 2 r L
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 -
BLOCKWALL.APPROVALS
POOLS - SPAS
Steel
Set BacksS
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
/geW Lateral / �—
Pool Cover
r Connection
Encapsulation
Ws 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:
Certificate of Occupancy
City of La Qdinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-120 BIGHORN TRAIL -
Use Classification: SFD Bldg. Permit No.: 9710-177
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RM
Owner of Building: MINISTRELLI-PAINTED COVE INC
Building Official
Address: 50-445 MOUNTAIN SHADOWS RD
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 5-20-98
POST IN A CONSPICUOUS PLACE
F77
7
P.O. BOX 1504 APPLICATION ONLY
Building78-495 CALLE TAMP.ICO
Address ri q I 1 0 I iaDP-A., t RA IL LA QUINTA, CALIFORNIA 92253
Owner
(�IIN751!'Fit ! t�t�n/S�"Ru[�Junl
Mailing
Address5-6q �N?A�lu S�RAOWS
CityZip Tel.
LAOUiAnA g1zS3 I 54LII- I
Contractor
M t 11 t li4m. 0_ 1. 1 - �� ► ►J �C 17 �.a
Address
p
State Lic. fifty
& Classif. Lic. p �UZS
Arch., Engr.,
Designer ST AA XXX r 19AJ4/Lb
Address I Tel.
City I
Zip I State
Lic. q
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 the alleged 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 (5500).
(_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, Bu/sness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds of 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
of 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.)
1'1 1, 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
n 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 (5100) 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, atter 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 sof this city to enter the above.
mentioned property for inspection purposes.
Signature of aQplicant —Date—
Mailing
ateMailing Address
City, State, Zip
WHITE = FINANCE
LDING: TYPE -CONST. OCC. GRP.
Number rlG q SQ D,2a
al Description 4 0 T •26 TP, 'P 5l12
ject Description -5r 1%
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
r Side Street Setback from Center Line
Set Side from Property Line
C
FINAL DATE' INSPECTOR
Validation:.
3 r TY !\f
! E
PINK = BUILDING DIVISION
YELLOW APPLICANT
Sq. Ft. rp No.
Size 16 d Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
rjQ • o0
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
r Side Street Setback from Center Line
Set Side from Property Line
C
FINAL DATE' INSPECTOR
Validation:.
3 r TY !\f
! E
PINK = BUILDING DIVISION
YELLOW APPLICANT
.1
-ro
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 11/6/97
No. 16233
Owner Name Ministrelli-Painted Cove, Inc.
APN # 769-550-020
Jurisdiction La Quinta
Permit #
No. 79-120 Street Bighorn Trail Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # 26 Square Footage 1
Type of Development Single Family Residence
Comments
Cirandt-a hered 3700 sq. tt.
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 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-Painted Cove Telephone 564-1849
;.
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson
Signature _29��_�.
t
,:
Payment Received -% -.$6,28,00
Check No. 75103
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 peril for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
rolled 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.lApplicant Copy - Applicant/Receipt Copy - Accounting
CITY OF LA QUI A
BUILDING & SAFETY DE".
APPROVED
FOR CONSTRUCTION
DA
EXISTING
RESIDENCE
AREA SCHEDULE
POOL
780 Sq. Ft.
POOL PERIMETER
116 Ln: Ft.
5PA (existing)
5q. Ft.
5PA PERIMETER (existing)
Ln. Ft.
5PA SPILLWAY
4 Ln. Ft.
5PA GOPING (exl5t14
5q. Ft.
POOL DEGK
1,398 Sq. Ft.
GOl1RTYARD GONG.
1,220 5q. Ft.
STREAM /POND
252 5q, Ft.
STREAM / POND PERIMETER
138 Ln. Ft.
4' HIGH BLOCK WALL
12 Ln. Ft.
GA5 LINE
Iq5 Ln. Ft.
DR1Y6wAY
GO
1
1
1
THESE PLANS, DRAWINGS AND SPECIFICATIONS ARE NOT TO BE REPRODUCED,
CHANGED OR COPIED IN ANY FORM OR MANNER WHATSOEVER WITHOUT THE
EXPRESSED WRITTEN CONSENT OF CLASSIC POOLS/SPAS
Landscaping 1
(760) 345-8302
Lic#C 53-935936.53-935936.
SCALE: 1/16"=1'-0"