9812-246 (SFD)LICENSED CONTRACTOR DECLARATION
U) 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
Cl)04 Professionals Code, and my License is in full force and effect.
O co License # Lic. Class Exp. Date
I W � U I9 13 &11/00
Z r gate' % Signature of Contractor
O V 1
UCID
C> OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
ce) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
CA
Q WORKER'S COMPENSATION DECLARATION
C) 2 ZI hereby affirm under penalty of perjury one of the following declarations:
p () 1 have and will maintain a certificate of consent to self insure for workers'
X W !�= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q C) I have and will maintain workers' compensation insurance, as required by
Ci C Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Canier Policy No.
aD D
r CY
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
96de, I shall forthwith comply with those, provisions. .._-------
vDate: / Applicant
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, indemnity
& 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
PERMIT#
BUILDING PERMIT
�X12-z4h
DATE Jt
Al VALUATION S19(, !)Z2 60 LOT -72 TRACT
`n
-JOB
SITE
ADDRESS 79-40:5 QUAIL CROMING
APN 769-542-022
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�1;vr1�;1'1L1 I,Li•P�11RI'1' I3 COVE, INC.
COVE, INTC.
7478511WA' III S1"F 105
7-1785HWY ili S'1i; 105
INDIAN WELLS CA 92210
INDIAN WELLS CA 42210
(70)776-4450 CBLff 3625
USE OF PERMIT
S NOU, rA.WLY D-WIRIi.i'wi
SrD - PE MFT DOES NOT INCLUDE-k3LOCE . WALLS OR POOL.
'1'id.AC7 C0N3:e'Ie1,' ;`r4VTd 3,1 3.00 .3
11()tkC1VPJkT10 1620.x) SF
(,:'eA1iAtiF%l'.:t1.F(13(:�I('1• tS:',Z.I.tt1 �}.'•
•
:�'�'A��it!a'.,ci.lia�Ct�J,'�'..It7".:e`..��'�i-d-,l[1�:;'��3iS7
i!?,'►,�2Z,f„3
yy r 2. ,,,i
�F�iRi�OT M"t, S�.it�illW�.k�RV
r;,'c�I•fS'Citt3C"I'1Cfid :=H:z !Ut-(i0(l-41ti-1)G1i $97y,11tr
IL41.1 1�l4yAL l}`- VVE 1i11'Of)() 9�A VVV S�%w, s1)
U.1-C11Cic;AL111 101-€iQt)-420-000
t7LVMl4fNQ*r FEC 101 -MI -419-000 sll'%1.25
Q'1 nNC4- MOTION VFV - RF,'41f) 101.(W -*14 140) It 14 69
(IR Al.7 KO i' IX 101 c1W 423.000 3111000
1 t4[' kA&r (tUr;,;T01(1s FEDI 223-000-443-342 V,2ati.22
Pk1-':A8E PLAN EU1-% V-4 31-:45
AUTIN 11311141 fr P1,A0?R 701 -IM -755- flf_X4 AA2 tt
FRI 01"'TIO IT 101.000- B9-318
C) tft-'T YI'A1', f."(INSf 1tlK"T'1C2N ANO PLAN f"11t?f',h`
LESS PRE -PAID PEES
-5250.00
40FA)l.1t:l"WM11' FEMS 01IE, NOW
S6,714.23
l I V rf •�,
RECEIPT\may X \�
/t 1
DATE
BY %
DATE FINALED
INSPECTOR
\ V\
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
, �-T9 ,S
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
Neater 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
Final
Utility Notice (Gas) IAA -
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:
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9�lommencing 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
P
593899 B 08/31 /2Lf
Date Signature of Contractors
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:
Carrier STATEFUND ND Policy No. 046.93-0004423
(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: 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#
DATE VALUATION LOTTRACT
04/1&1% $196=.60 1/2 25429
JOB SITE
APN
ADDRESS ��_W5 QUAL eRos.;INC3'
769-542-02.2
OWNER
CONTRACTOR/ DESIGNER / EN INEER
MWS: RF U_PfM11M COVE, ITC.
)"IMItI:U l -PAINTED COVE, INC.
747851~IWY 11 IM 105
74765 HWY' 111 STT 105
:[Iv'',DIr` T WEIIS CA 92210
1NDIANWMLS CA. 92210
(+60)776-4450 CBJ.R 382x.
USE OF PERMIT
1�1Att3I$ �..vi IJ��NCI
.
SFD - PERMIT DCJMS NOT IRIC LUDE BLOCK WALLS OR POOL.
TRACT C4103TRUCTIO:N M78.00 SF
f
PORC,"WPA'4IO 620.00 SF
OARA.UF/CARFORS 822,00 OF
Y11V TED COST OF CONST UC: ON
1 JC,92:2.�53
PERWf IsKE "MARY
COMTRUCTI: N FELE 101 X000-118-000 079.00
PLA14 CHECK Fit;E 101-000439-318 $946.59
MECHANICAL FEE 101.000.421.000 $93,50
ELEC:TI11CAL F1?X' 101-000-420-000 $224.67
PLUMBING iEF 1016000.419000 $261,25
S"TUXOMOTION FRE- RESIFT 101.000-241-000 $19.69
r3R"' IiNO HE 101.000-423.000 $20.00
INFI',.ASTRUC'TUPY, "LE 225-000443.34.2
PRECISE PLAN 101-000-441-345 Viol)
ART IN PUBLIC PLACES p RRSIE 701 -000 -IM -000 $142.131
FEE DEPOSIT 101.000-439.318 4250140
SUR-'TMAL CrO21:1WUMON A:tT PIAN C-1-MICK
$6,964.23
IXW PARE -PMD F
4250,00
':VO f ,P?+-;9�M 1 :MTE !?OW
$6.714-73
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
et 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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
g2 0(e
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
_
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
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:
Building
Tit!t 4 4 Qum&
P.O. BOX 1504
78-495 CALLE TAMPICO
��/) �Ue4/6 ,iPC)SSrrtl( LA OUINTA, CALIFORNIA 92253
Mailing
Address Til /J Sf
Ne I,,,- I iiZ//) /1
Contractor
/'f/,ll/ : 7l7!/1/
Address
City lZip Tel.
State Lic. City
8 Classif. Lic. #3 / 2 e5/
l C9
Arch., Engr.,
Designer
Address Tel.
City IZip ILic. State#
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 Contractors 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).
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 I 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'] I 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. O 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: d, 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 sof this city to enter the above•
mentioned property for inspection purposes.
Signature of aQplicant Date
Mailing Address
City, State, Zip
APPLICATION ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number
6gal Description L ., 7 %"R • .2S ��� �i
Project Description S�r>
Sq. Ft.�l r1�
Size ((
No.
Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Front Setback from Center Line
Ira;
'may-n,�_< _7A/b, A ti �n rn A.
1/07t�OTZ-
ff6�'
Side Setback from Property Line
t
FINAL DATE
INSPECTOR 1
P(2-o,v`
Issued by:
Date Permi
Validated by:
Estimated Valuation
OCT 2 9 1998
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading Al
Driveway Enc.
Infrastructure
TOTAL
REMARKS
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
t
FINAL DATE
INSPECTOR 1
s;
Issued by:
Date Permi
Validated by:
OCT 2 9 1998
Validation:
'ITY OF LA QUIIUTA
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION j
kC
Desert Sands Unified School District
Notice:
47-950 Dune Palms Road
La Quinta, CA 92253
.i
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 1/7/99 APN # 769-542-022
No. 18213 7 Jurisdiction La Quinta
Owner NameMinistrelli-Painted. Cove, Inc. Permit #
No. 79-205 Street Quail Crossing Log #
City La Quinta Zip 92253 Study Area
Tract # 25429 Lot # 72 Square Footage 1
Type of Development Single Family Residence No..of Units 1
Comments
Grandfathered, 3,178 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 add4hat building
Permits and/or Certificates of Occupimcy Occupancyfor this s uare footage in this proposed projeck',Triay npw be issued
Fees Paid By CC/1st Community Bank/Kevin Petersa' ` LV
{T iephon(6 564:,1849
Name on the check r, fj.A� ;� `E
By' Dr.- Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green
Signature
Payment Received
Check No.
$628.00
083775
NOTICE: Pursuant of Assemblf dill 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 ate 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 Dislrict('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
,t4
PUBLIC WORKS CLEARANCE LETTER
FOR
CUSTOM HOME LOTS
t
Dear,Builder:
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
COMMENTS:
TRACT:.
LOT:
PUBLIC wqRkS AUT RIZATION I DTE .
FAPWDEPTIDOCSTORMSIPW CLEARANCE LETTER.ss
OCT -22-98 THU 03;14 PM MDS CONSULTING
MDS CONSULTING-
PLANNERS
ONSULTING PLANNERS • ENGINEERS • SURVEYORS
17320 RedWU Avenue, Suite 350
Irvine, CA 92614
October 22, 1998
Engineering Department
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
FAX NO. 714 251 0516 P.01
Post -it° Fax Note
7671 DWO I - pof
oy►
To
From i7
Comept.
45.0
Phone *
Phone e
Fax!!^1ol
Fax et
Rough Grading Verification
La Quinta - Tract 25429
We have checked the area referenced below and find it to be in substantial conformance the approved
rough grading plan.
Lot #
Elev.
As -Built Elev.
Variation
54
45.0
45.1
0.1'
57
46,1
46.1
None
65
47.3
47.3
None
66
48.1
48.1
None
70
50.5
50.4
0.1'
�
�
N nem
73
47.3
47:3
None
74
47.0
47.0
None
75
46.6
46.7
0.1'
Stanley C. Moly
R.C.E. 20596
Expires 9/30/01
G:%307\041aer-r%54.57.65-66.70.72-75.doe
o Q,�pF ESS ipN
C.
No. 20596
Fxp. 9-30-01
�f r
F OF CAO_
s
STANLEY C. MORSE GARY DOKICH SKIP SCHULTZ
*;(DEC -22-1998 01:44 PM CAL WEST ENGINEERING 760 328 1583 P.08
CAL WEST ENGINEERING
32-812 Aurora Vista, Cathedral City, Cu. 92234 (76o)378-8150 fax(760)328-1.583
December 21; 1998
Tom Hartung
Building Official
City of La Quinta
Re: Truss Review for Lot 72 /Painted Cove. La Ouintg
Dear Tom,
We have reviewed the truss submittal package prepared by Spates Fabricators for the above project and
found it to be in substantial conformance with the approved plans.
If you have any questions or concerns please call.
Si cJYaun
4
Je S.E.
of ESSIO/V
B. YOG C�2
No. 4044 ��' Z
m
w �
Cr
Exp-
"RU
xp "RU
OF CAS\F