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0512-057 (BLCK)u2 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with W Section 7000) of Division 3 of the Business and Professionals Cade, and my o� Q Lo License is in full force and effect. 497804 C29 9/30/96 r W Aense # Lic. Class Date Zte_ Signatureof Contractor F- o) OWNER -BUILDER DECLARATION J IU ' I hereby affirm that I am exempt from the Contractor's License Law for the CL 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 � Date Signature of Owner N rn WORKER'S COMPENSATION DECLARATION CL Q I hereby affirm under penalty of perjury one of the following declarations: Z () I have and will maintain a certificate of consent to self -insure for workers' L Occ compensation, as provided for by Section 3700 of the Labor Code, for the X W LL performance of the work for which this permit is issued. p J J () I have and will maintain workers' compensation insurance, as required by M Q U Section 3700 of the Labor Code, for the performance of the work for which this p U permit is issued. My workers' compensation insurance carrier & policy no. are: WLOCarrier SMTE FUND Policy No. 22.995 Z (This section need not be completed if the permit valuation is for $100.00 or less). r- 0() 1 certify that in the performance of the work for which this permit is issued, d I shall not employ any person in any manner so as to become subject to the g 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 ro visions. ' Date: ✓ _ Applicant '"" Warning: Failure to secure WorkersCompensation 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 application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, 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 inform d n ist� 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 purposes. �y /Si 3nature (Owner/Agent) Data ALC0,,BUILDING PERMIT ZI PERMITV.41J_,ijJ-J DATE VALUATION LOT TRACT JOB SITE ADDRESS 79-125 BIGHORN TRAIL APN OWNER oe CONTRACTOR ST1:VF EI,LINGMN WI SONR Y N'IMIS1RELI,I•PAIN F01 COVF,, 6805 PANORAMA ROAD .50445 MOUNTAIN SHADOWS RD CA MED'RAL Cl'I"Si CA 92234 LA QUIM-A C;A 92253 (619)320-9481 CBL# ;may (6)())5(V,4 -J849 DESIGNER/ENGINEER USE OF PERMIMIP4 Bt3ii. Vis 70 LY OF 6 N10H GARDEN BLOCK WALL, FEE DESCRIPTION FEES IS P 1. WALL IU.UU LF IN.STii1IMED CAST OF CONSTRU HON 1,750.00 PERMIT 1' EF, SUMMARY CONSTRLICTION FEE 101-000-418-000 $45.tu► SUB -1 fAL CONSMUMON AND PLAN CHECK $115.04 LESS PRE-PAIL)FEES $000 TOTAL, PERMITPEM DUI: NOW $45.00 kc4� ,. I ECEIPT ��, DATE BV DATE FINALED 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 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 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 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated 619-775-3500 Date 8/15/95 Type of Permit I La Quinta No. 113612 Permit # Owner Name Ministrelli Construction Log No. 79125 Street Big Horn Trail City La Quinta Zip 92253 Study Area 125 APN # 769-550-011 1 Tract # 125429 1 Lot # 18 Square Footage 1 Type of Development Single Family Residence I No. of units 0 Comments 3247 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 This certifies that school facility fees imposed pursuant to Mitigation Agreement in the amount of 628.00 X 0 or $ 628.00 have been paid to D.S.U.S.D. for 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 Ministrelli-Painted Cove, Inc. Telephones~,5644849 Name on the check r - N By Dolores A. Ballesteros Superintendent Fee collected /exempted by Pauline Pearson r J Payment Received:-' . " Signatures 11►'n„ d, Ald1� n ��^ $628.00 Check No. 1733 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 P.O. Box 1504 APPIICATION�ONLY Building �- Q1Z 7 � //� /i tL QUINT CALLE CALIFORNIAESTAD9 Address / �� ,�/ LA QUINTA, ORNIA 92253 Mailing Address city i. Zi �� Tel/V 117 r W Contractor � v Address City IZip State Ljc.�� ( City &Classif. l%oJl Lic. # ... _-.., _..—., Designer Tel. City v Zjp State G�?'7tG LD. # 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 or 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 ($500). l: Las 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.) ( 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.) I l I am exempt under Sec. B. 8 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 r7 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 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- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip BUILDING DIVISION BUILDING: TYPE CONST. anl_/_�0CC. GRP A.P. Number t_egal Description ` Project Description` Sq. Ft. �7 No. No. Dw. Size ` I Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ IEstimated Valuation fp i qtI, r 7,� 0 oO PERMIT AMOUNT Plan Chk. Dep. Distances: Plan Chk. Bal. • Z Const. T7 2 .00T Mech. , O Electrical 200 •6 Plumbing g7 SD S.M.I. INSPECTOR Grading Driveway Enc. Date Permity Infrastructure 2 Validated by: z Validation: c TOTAL REMARKS In.,, liA ,r t. /G!/.L //1 h1ili ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop :y ine Side Street Setback frorm) enter Li e Side Setback from'Property Line `• \� FINAL DATE INSPECTOR Issued by: Date Permity Validated by: Validation: CONSTRUCTION ESTIMATE GROUND PLUMBING NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. g $ n !� UNITS / HEATING (ROUGH) STORAGE TANK 2ND FL. SO. FT. 6 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK Y ARD SPKLR SYSTEM GAS (ROUGH) ! --- MOBILEHOME SVC. OTHER APPJEOUIP. BAR SINK GAS (FINAL) POR. S0. FT. @ GROUT WATER HEATER SERVICE GAR. SO. FT. 2,0 1POWER OUTLET WATER SYSTEM ROOF DRAINS GRADING Cu. yd. g plus xb =$ LUMBER GR. FINAL INSP. DRAINAGE PIPING FINAL INSP. CAR P. SO. FT. ROOFING REMARKS: WALL S0. FT. VENTILATION DRINKING FOUNTAIN SO. FT. @ FIREPLACE URINAL ESTIMATED CONSTRUCTION VALUATION $ SPARK ARRESTOR WATER PIPING GAR. FIREWALL NOTE: Not to be used as property tax valuation LATHING FLOOR DRAIN MESH MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD FINISH GRADING SIGN WASH E R(AUTO)(DISH) (ir APPLIANCE DRYER CERT. OCC. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED INSPECTOR'S SIGNATURESlINITIALS JLAUNDRYTRAY AIR HANDLING UNIT CFM GARDEN WALL FINAL KITCHEN SINK 2 ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET 2 COMPRESSOR HP �� POLE, TEM/PERM i LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT 22 SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. p c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/- c SEWAGE DISPOSAL SO.FT.GAR @ 3/c HOUSE SEWER 2 Z. 90 GAS PIPING PERMIT FEE PERMIT FEE / PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE . _ CONST. FEE ELECT. EE SMI FEE PLUMB. FEE . D [J�.�UC. 'LL, ql� - 00 - .000 I 1 l X83 o STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING Cu. yd. g plus xb =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL