9608-034 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (corRmencing 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
py�ilU � hi31./+
Date��Signature of ContractorF
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 AFFILIA 1.0INUljST Policy No. 4045737K04
(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: AgnL pplicant
Warning: Failure to secure Wo, kers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection pur oses.
Signature (Owner/Ag m Date
PERMIT# CONTROL#
BUILDING PERMIT
x.1,34 4114
DATE VALUATION S133,941116." LOT ifs TRA �OIfi
JOB SITE 7$-90 RIVIM IM i OCK
APN 7645k-4;4-1-4
ADDRESS
O NER
CONTRACTOR/DESIGNER/ENGINEER
:fitINIS"rR_EL,.11 T .tP.m) COVE,
X0445 MtN.f'N"CA.IN SRALA.)WS RD
:0445 h#[ UN'1'AIN SHADOWS RD
I,A(j1JIN1'A OA 02253
I,AC,1111WrA CA 922 S3
[(+1u1'`[�.1.1ii�1
f(i11a)ge'►9-iRat� C'A1.4 zt..S
USE OF PERMIT
'S1N411,11'1;Ah111.A 1 WE'1.1,1INti
!IC11•-ROM1111' IWI t 11)>ES 16R LF (►1', El' ANI) SO 14 O1'` V 0 ART 'N WAL1. POOL PERMIT Tf I RE
()fill,AIN11141-PARATF•LY
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( )ARAf ifYCARVICiRl' fill' fol IV
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11331x.90
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I'll, A14 4,1 IUCTs 11:1' I0, 1 000 •1:15 319 Sb 1C).?tti
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hik-cX11ANlr"ref, f44; 1011.0k-421-000 553-1+)
R1 f?("PRWAI 1.1111, 401: [![)1!.,190-9)Rft %tots 79
11.11X1111111[;1 1'. WI W0411"1000 3 S1. 2' (YJ
';'Ic )NO H_1,. - Itfi I.4IJW 513.0
t414AI.NNO Hf+1; 101.4XV-4214 )o s2D.00
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T \ 1 +�• I . •Ss.r r i.;,� t.,. �,1 .., : V \!V0 t iN:llj ,h.1`/ i
st ifill rf,k 1. t`( 0�rkIT("1110N .1N MAN C:.'M,CK
$4,758.14
r.1&S 1>rcE-raAtD Ft..fs
41V 00
n
- 4-M, PINrMI'i- itf,rs DUE N0VV
$4,"8.14
J SEP 1 :, 1996 U'
gy
- A
RECEIPT
DATE
BYY
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 Pibg. 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
Ex:2rior Receptacles
G.f .I.
Smoke Detectors
T&1p. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
*OF,ITY OF LA UINTA,B I;G •&.SAFETY DEPARTMENT
�. 9,9 777-7012
SPECTION REQUEST LINE +�
777-7153
Owner MINISTRELLI
Contractor MINISTRELLI
Permit Number 9608-034
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-960 RIVER ROCK
INCLUDES 168 LF, 6'& 50 LF, 5' GARDEN WALI
(NO POOL)
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL O- 6
MAIN GROUND SYSTEM
GROUND PLUMBING Q� -
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST ; -
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION / E
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
EWE SEPTIC TANK
FINALS
ELECTRICAL S�• y /
PLUMBING
FINAL GAS TEST _
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED - 2
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
7/96 TURN ON UTILITIES OR OCCUPY BUILDING
i P.O. BOX 1504 APPLICATION ONLY
Build'IYIg �y�►�� /; ,fr./� / 7&105 CALLE CALIFORNIAESTAD9
Adrirecc //IISS/«/X/✓ fi ��//rrGG� QUINTA, ORNIA 92253
�I 4--f ( — .
Mailing _-15
Address 5 ��J
Cit 7 Tel
A-f�a[yipz_�
Contractor
Address
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address I Tel.
CityI Zip I State I
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 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).
f7 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
Prolessions Code: The Contractor's License Law doesfhotjapply to an owner of property who
builds or improves thereon and who does such worlr 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.)
17 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
0 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
ateMailing Address
City, State, Zip
BUILDING DIVISION
BUILDING: TYPE CONST:./,�/. / OCC: GRP.
A. Number 6 — 5_'/L—
/ L— D! 7
Legal Description oo
Project Description r ►/
Sq. Ft. No. No. Dw.
Size - Stories Units
New O Add O - Alter ❑ Repair ❑ Demolition ❑
9!&d�itZ 4404A"
Itimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
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
Side Street Setback from Center Line
FINAL DA'
Issued by:
Validated
Validation
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F,�
1ST FL. SQ. FT. a $
2ND FL. SQ. FT.
POR. SQ. FT. (y
GAR. SQ. FT. @
CAR P. SO. FT.
WALL SO. FT.
SQ. FT. Qq
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM c`
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPIEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ, FT. Q c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SQ.FT.GAR @ ?/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST, FEE ELECT. FEE
SMI FEE PLUMB. FEE
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 APPIEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATI ONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Notice:
Document Cannot Be Duplicated
Desert Sands Unified. School District
82-879 Highway 111
Indio,.CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/13/96 APN # 769-541-034
No. 14851 Jurisdiction La Quinta
Owner NameMinistrelli Construction Permit #
No. 78-960 Street River Rock Log #
City La Quinta zip 92253 Study Area 125
Tract # Lot # Square Footage 1
Type of Development Single Family Residence No. of Units 1
Comments
Grandtdthered Project - BaJada
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 Government Code 53080
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 B Ministrelli Construction/Cashier's Check '`
Y �Teieph�one _,564-1849
Name on the check
By Dr. Carol McGrew ti rf
Administrator in Charge
Fee collected /exempted by Ellen Patino Payment Received $628:00
.Check No. 067174
Signa ure /
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
CARLOS ELIAS
REGISTERED CIVIL.ENGINEER
38825 Charlesworth Drive -
Cathedral City, California 92234
Telephone (619) 328-7271
August 45, ;1996
City of La Quinta
Department of Building & Safety
78495 Calle Tampico
La Quinta, Calif. 92253
Gentlemen:
This letter concerns the Min.nistre:l.li re-s i dence.t to be
constructed in the Bahada Tract, La Quints, California.
The design of the roof trusses by Spates Truss Company
is in accordance with my structural design.
Very truly yours,
Carlos Elias
CE;Je r