9707-075 (SFD)LICENSED CONTRACTOR DECLARATION
Ihereby 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`l 26 ° '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.
Y) 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" :r':
f Policy No.
�`i`'i. uF _.Ti `tLlf}�f F'�'�fi�3tlGl i�3
(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
J
Code, I;shall forthwith comply with-those'provisions.'` Date: r 4 bv4� Applicant l i>,a/�' J;✓... ✓�
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 'representd-tives of this City to enter upon
the above-mentioned property for Inspection purposes..
Signature (Owner/Agent) r L ''' a Date
BUILDING PERMIT PERMIT#
9707_075 -
CONTiR�OL#
1
;
VALUATION $133.40 LOT ' �t) TRACT 26U16
DATE8/V4F7
2
JOB SITE
79 -ONO R.{V.ILR..��OCK
APN
: 70 -:)�b�•
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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-30445 X40UN"t".rV1 tiHA- WS 'RD -
LA. QIJT rA CA
(A'_ QUINT.A.
CA. 92-253
(760)564 1849
C:'j31 N -X15
USE OF PERMIT
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6 i8 -Ir- rAIL C rMISUR tPON AND P.CHECK
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
01 —
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
/h
Drywall - Int. Lath
j(,�
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
I I
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
/g, 7EFT
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:
-
Desert Sands Unified School District
Notice: 82-879 Highway 111
01
922
Document Cannot Be Duplicated Indio, C619 -77A A 922
CERTIFICATE OF COMPLIANCE
Date 8/25/97 APN # 769-541-011
No. 16006 Jurisdiction La Quinta
Owner Name Ministrelli Construction
No. 79080 Street River Rock
City La Quinta zip 92253
Tract # Lot # 16
Type of Development Single Family Residence
Comments
Cirandfathered 2374 sq. ft.
Permit #
Log # .
Study Area
Square Footage 1
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
ti
Fees Paid By cc/First Community Bank/Ministrelli Construction Telephone 564 -1849 -
Name on the check '
By Dr. Doris Wilson^ `
Superintendent
Fee collected /exempted by Pauline Pearson Payment Received .$628.00
Check No. 74002
Signature g_
IOTICE: 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
bove wilt begin to run from 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
ollect 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
August 14th, 1997
MINISTRELLI CONSTRUCTION
50-445 Mountain Shadows
La Quinta , California 92235
ATTN: Ken Schmale
RE: Roof Truss Calculations and. Layouts on " Bajada - Lots rr and 10" for MINISTRELLI
CONSTRUCTION CO. to be built in La Quinta Ca.(ESI/FME 794-6536)
r
Dear Ken:
We have reviewed the calculations and layouts by SPATES FABRICATORS for gravity loads
and drag loads, they appear to comply with the requirements of our calculations and plans.
The review of these drawings does not relieve the contractor, from compliance
with the drawings and specifications. This check is only for review.of general
conformance with the design concept of the project and general compliance
with the information given in the contract -documents. The contractor is
responsible for confirming and correlating all quantities and dimensions,
selecting fabrication process and techniques of construction, coordinating his
work- with that of other trades, and performing his work in a safe and satisfactory
manner.
Thank you for your attention to this matter, please do not hesitate to contact us if
we can be of further assistance to you on this project.
Sincerely,
ESI/FME,
STRUCTUe
By: Zit
Danny M
for ESI/F
1921 EAST CARNEGIE AVENUE, SUITE 3J SANTA ANA, CALIFORNIA 92705 • (714) 261-1811 FAX (714) 261-8506
Certificate of Occupancy
City -of La. Quinta
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: 79-080 RIVER ROCK
Use Classification: SFD Bldg. Permit No.: 9707-075
Occupancy Group: R3 Type.of Construction: VN Land Use Zone: RL
Owner of Building: MINISTRELLI-PAINTED COVE INC.
Building Official
Address: 50-445 MOUNTAIN SHADOWS
City: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: 2-17-98
POST IN A CONSPICUOUS PLACE