9905-141 (SFD)I—
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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
Date 1 ' 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.
( ) 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:
Camer Policy No.
1 a'M fi i 1 l;sF1? 0,10,99-040 6923
(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.
Date: Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for. inspection purposes.
,Signature (Owner/Agent)' �" Date
BUILDING PERMIT PERMIT#
"05-14A
DATE VALUATION S2117,AS9" 0 LOT 1 TRACT 2N129
B SITE / • .,
JODRES
APN
79-i1f�5 33IC:3lO�:ir iKnlL
769-5.�l 408
OWNER
CONTRACTOR / DESIGNER / ENGINEER
jOIINIr [RL,$ T4?Nf"'In ) oowi,1im'C'
%, 1101 ISTRE L U -PAI: TE€) C 10%T, NIC.
7,1785 HWY 11I ME 105
74.785 4INVY 1.11 S Z? 105
INDIAN WELLS CA 92210
INDIAN WELLS CA 92214
(76q)776-4450 CI31✓f! 3623
USE OF PERMIT
S.FIKOL F, PAWLY DWEL,1,►f G
X13 - P1 "HT DOES NOT INS LbDrt. HLC>C-r: WALLS OR POCX..
1".RAC`.fl' C ONSTRIX 3 (ON 3,667.110 8F
F
V(D'KC IPAVO 340.00 514
G.ARAC1{r/C:A1ti''ORN 727.uo SF
'ES1RcUTUWCOST 01 (6)WtHUCT1O.N
Z17,1",1,30
tRpp FEE' S4pAMAIRV
+ 'r 1N3T ? VC T10NFEsE.'191-000-418d}(i(J S1.052.50
PT, b,Nt:"F(Et tt 11'3= !f2 R#�fi6.01
"i IC11AINIC AL 1�'.I 13 14I"I)4t1-4 1-00- 0 $130,50
ELEC1'I21CALFES i01-000-•420-000 S,215.39
PPI AM13INQ1� 1-11,17 101.,CIt6419-O lit S if�.uu
S7't t"tiVfi Adt�3'ir1i�wv W r -`810 101..1N10_7itI-fJ()O ^'3
:J ;',,L'f;Nc, E'E 101.000-•1023-1 M S21).0
IN i AS'i:iCUC'CURL; T -IE 225 -Ca -443-342 $4,ftOO,76
ART iN PUBI.h; PLA4:*1:8 - "101 -WO -155-000 5294.72
t~ H r1PPg>�r -s—ni (-)A
SiJFR-'IY.TAI, C'C1NS'( 0.fC'I"ION A.ND PIAN C11i.0 K
•$7,6(19.67
LESS 41"Pd'-PAID RX'S
4^50.04
TOTAL P$+,RMVI';i+;j CSS 014,' NO
.7.359.17
I'
RECEIPT
DATE�i �j/
BY j
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
cL
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection L
Encapsulation
Gas Piping
Gas Test
71-12F R
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lor Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 00
Utility Notice (Perm)
COMMENTS:
Dear Builder.
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
7*6 <-
1
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)
•J _. � Y. ��, if
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 WVERNAL USE BY PUBLIC WORKS DEPARTMENT 7i
COMMENTS:
TRACT:
F: MS1PW CLEARANCE LETTER.ss -
Notice:
Document Cannot Be Duplicated
Date 5/13/99
No. 18749
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Jurisdiction
Owner NameMinistrelli-Painted Cove, Inc.
N. 79-065 C. Street BighornTrail
City La Quinta zip 92253
APN # 769-550-008
La Quinta
Permit #
Log #
Study Area
. Tract # 25429 Lot # 15 Square Footage 1
Type of Development SFR Mitigation No. of Units 1
Comments
Jran at ere - 3,667 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
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„
ti
permits and/or Certificates of Occupancy for this square footage in this proposed projedt9may now be issued
• 'r
Fees Paid By CC/1 st Community Bank/Ministrelli-Kevin Peters T.elephonej
Name on the check
By Dr. Doris Wilson
rr -
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received $628.00
Check No. 085819
NOTICE: Pursuant of Ambly 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 fd6rn 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
collect 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
k
S�-,,�,4JON TANDY
330 Meool Ave.
eVltDIFy'C � Palm De ert, CA 92211
�I, `
Office (760) 772-7192
SPECIAL INSPECTIONjFax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE 0 STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
pl- F poy.Y
O OTHER
JOB LOCATION
-79- S PJi iAz)P- J 9- 1
l,c. ��*JVa
REPORT SEOUENCE NO.
TYPE OF STRUCTURE
SFS L-,,, - �iS ® �.� C'��E
PERMIT NO.
9io5- \yk
DAT
9 4
DAY OF WEEK
MATERIAL DESCRIPTION
,I -J- C-160
ARCHITECT
86 61
INSPECTOR
9-;
HRS. CHARGED
ENGIN ER
Sc:j;� I Fr -&F
ASSISTANTS
HRS.CHARGED
INSPECTION GENERAL i
DATE CONTRACTOP. �. 5 +
SUB
CONTRACTOR
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE D
PAGE 1 OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO 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.
SIGNATURE OF ISTERED INSPECTOR
F C�o//li3Z�--y9//li3Z�--co
DATE OF REPORT REGISTER NUMBER