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LICENSED CONTRACTOR DECLARATION
by affirm under penalty of perjury that I am licensed under provisions of
:61,19 (commencing with Section 7000) of Division 3 of the Business and
ovals Code, and my License is in full force and effect.
Lic. Class Exp. Date
q0389908131no(
Date 6 ` (' Signature of Contractor—,
ontracto " �•.x
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 ani 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:
Cartier Policy No.
i'a°'I t;1tF f od b 1 c}?
(This secti§n neled not completed if the permit valuation I or$1b .0� or'�ess)
( ) 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: "r t I 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,E
application. i.
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 ifY'
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.
d
Signature (Owner/Agent) i �'" % . `" i f Date' t! j e .
BUILDING PERMIT PERMITN
DATE,, VALUATION LOT "07_1 TRACT10
JOB SITL
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MINIS17RLLLI-PAINTED COVE; INC,
MINIS"TRELLI-PAINTED COVE, BIC.
74785 HWY I1 I STTE 1.05
74785 H%VY 111 STE 105
INDIAN WELLS CA 92210
INDIAN NVELLS CA 92210
(7m)),776-4450 CKA' 3625
USE OF PERMIT
-D - FhkMIT DOES NOT INCLUDE BLOCK. WALLS OR POOL.
'1 RAC f COM. TRUCTION 3.`247.00 8F
POitCHIPATIO 392.00 SF
GARAGWCARPORT 127.00 SF
1 S',UIN `i'ED COSI' OF CONSTRUCTION' ION'
195,774.90
PERMIT EEE SUMMARY
C074STRUCTION FEE 101-000-41"00 5975..%
PLAN • CHECK FEE 101-000.439-318 $331.84
FE13 DISPOSIT 101-000-439-31.8 4250.00
MECHANICAL FF„E 101-000-421-000 -M.50
a C*rR1CAL FEE 101-400-420-000 $12119.69
PLUMBING FEE 101-000-419-000 5 19.25
STRO1 G NIOT .ION nE - i2E= 101-000-241-000 $19.58
GRADING FEY 101.ON-423-000 $200
11QgUV51RUCTUR FEE k 2y5-000-443342 $4.287:63
1 ART, PUBLIC PLA.0 S • RE= 7' i-000-255.000 $7.39.44
,• '' /// SC:(.E= f+C7i*A.C. CONSTRUCTIONAND PLAN Cl,JECK
LESS PRE -PAID FVES
�6,91I 1.�t3
-%250.00'
TOTAL PERINUT FEES DUE NOW
SB,661.43
1
RECEIPT
DATEBY
DATE FINALED
INSPECTOR
INSPECTION RECORD
.OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Y -t
Set � Underground Ducts
Forms & f-ootings Ducts
Slab Grade Return Air
51
Steel Combustion Air
Roof Deck �- Exhaust Fans
O.K. to Wrap — F.A.U.
Framing _ Compressor
Insulation U - Vents
Fireplace P.L. Grills
Fireplace T.O. Fans &Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall `
Exterior Lath Z
Drywall -Int. Lath Z
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 d�
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures .
e
Main ServicCA
Sub Panels
Exterior Receptacles
•
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
O�
Utility Notice (Perris)
• "
Oif oTECf2EE�L P.O. BOX 1504 APPLICATION ONLY
Building�f 'r— 78-495 CALLE TAMPICO
Addres/?U S--f--ry xt� LA QUINTA, CALIFORNIA 92253
Owner
/N/ 5i ilfi [ / V/V STiPrJc 7'> ON
Mailing L /,
Address
City fj�, Telz/a �74Z/1/mo6
Contractor
ress
ip
State Lic.
& Classif.
/
(Q 1.3
City
Lic. #
Arch., Engr.,
Designer
Validated by:
Validation:
Address
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,Susiness 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).
t-! 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 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 contractors) licensed pursuant to the Contractor's License Law.)
11 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
n 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 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. -
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 ap
Mailing Addres
City, State, Zi
.DING: TYPE'CONST. OCC. GRP.
033
Number '%G o e��
I Description /O;. Ev 3 q
act Description f7 r -b
Sq. Ft. / N
No. o. D .
Size !' Stories Units
ew ❑ Add ❑ Alter ❑ Repalr n ❑
4_/a %jos / 7'J" i
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. 2,�(�
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY: i
Minimum Setback Distances:
Frorft Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPEC
Issued by:
Date Pe i
-101999
Validated by:
Validation:
a �
I
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
I VO
0i AGV3H'OT-A3!A3iH
--ANM
d
U 00 b 0 -3 -1J
AGV-3 J
03-J.11VOIS 1,103HO NVId
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 7/12/99
No. 19031
Owner NameMinistrelli-Painted Cove, Inc.
No. 79-205 Street Coyote Creek
City La Quinta
Tract # 25429 Lot # 39
Type of Development SFR Mitigation
Comments
-irandtathered at sq. ft..
APN # 769-550-033
Jurisdiction La Quinta
zip 92253
Square Footage
Permit # 9907-110
Log #
Study Area
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 . J. the amount of _
628.00 X 1 or $ 628.00 the property listed above and chat building—
permits and/or Certificates of Occupancy for this square footage in this proposed project mdy now be issued
Fees Paid By cc/1 st Community Bank/Kevin Peters Telephone
Name on the check
let- t
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $628.00
Check No. 086518
Signature�j� / C�
NOTICE: Pursuant of Assl5mbly 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 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
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
JUL-22-1999 08:29 ESI/FME 949 261 8506 P.01i02
_ESI/FAME, Inc.
�t STRUCTURAL ENGINEERS & CONSULTANTS
July 22, 1999
MINISTRELL) CONSTRUCTION CO.
50-445 Mountain Shadow
La Quinta, CA 92253
ATTN: Kevan Peters
RE: Roof Truss Calculations and Layouts on "PAINTED COVE", Plan 313" -Lot 39 to
be built in La Quinta for MINISTRELLI CONSTRUCTION CO. (ESI/FME 194-6225 /
BBG 124-0612)
Dear Mr. Peters:
We have reviewed the calculations and layouts by SPATES FABRICATORS and 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.
In addition at your request, Our Office will provide field observation for the above mentioned
project.
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, Inc.
STRUCTURAL ENGINEERS
By:
Danny Matsumoto, CE33307
1921 E. CARNEGIE AVE., UNIT 3-J, SANTA ANA, CA 92705 • Ph. (949) 261-1811 / FAX (949) 261.8506