9604-034 (SFD)U)
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LICENSED CONTRACTOR DECLARATIONS
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
699)9 f3 R131/ck3
Date 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:
Carrier Policy No.
114_14,51378034.
(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: ADolicant
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 J/ CONTROL#
9604.0.4 3267
DATE 7/96 VALUATION �'Z.1�{.:�1 LOT TRACT429
JOB SITE
ADDRESS W-065 C()WYM CREEK
APN 769L-550--026
OWNER F
CONTRACTOR/DESIGNER/ENGINEER
MI.N,r1ST.n;FT,f..t-�`*�1 !°rr C�Qtr�,..
Mtl`a:tSrr,ELLI-1'k1.Ct�,TEDCOVE,
50:445 IS40{,.t91-A1N 9:11&DOMS.
50445 ivl0ill�"I'A11v �13��[�OV�` :2-T3
I.A. w1N'i A C'.A.:Y2 F%3
LA QU1N't'A CA. 92253
Ifil.t3,�56�I tis49
ftit t;ii•t-4RaS! CRL4 3625
USE OF PERMIT
ti1flt.�i,4•; h'A�i.f1..�� 1'-3�i+.f1.,1,I:NC'�
. .
PR.I 41117'D">OES N0'i ,(—N0AJDJi RLOC:K WALt.: OR, POOL, AkT fN PUSIAC 1'1,A<U:,4S <:REbn,'.
MOO, "K?"s/<` E NC3W4 t\ $�',r1.0c1 C ��t7['1 1>; Cli�ils"N FOR I'M, ALTS W 1'i` 80-1 F`?',Ac + Fttr ON
LM 56 WHLK.H WAS.PAIf1:13i' X11S'1't1NT3.
POIRC H/PATIO 3�f�,Ot1 SI
CZAR A0131 .Q.PC1RT 64%6.00 3
US1 fhI'f1,TE, 1) ( ii !7F (:'Oi>!S"111 ylM 1t N
1ia]Mt;d IT at�'43 E 3'f,itN'ItMAR,`Y
FL-�p: -5r2y5'Jl .4d7i
�l.):�:^c{'0'!;(IT }^y
N. AN l'.Cll.`A.+yK.FEt- 10140-13q-318 $7�i1.Sx
C;` NSTR!<JCTION FEF 101.000-44i34W $ 95.tN3
-cCNtIN CAL ME 101-000.42l -000 S9i. 30
ELl c.1R CAL ftl, 101-000420-000 $185.07
KiMal-NO ME 101-000-4.19-000... 51.76.00
310NO !vlO'E,ION Ffi-13WSID . 1014)0-241.6000
CYRAial;NC FEE 101.000.4.23-000 $20.00
W2Z.t' .-MI1 k,.1'L{.R.E FW,!, 215-000-443-342 $3.7Fi3.211
ART IN PUBLIC PLAC lsi - PS9W 701.-+OtiTi-2.15 GOO, _325t00
UR-tWAL COt+,'S TRUC''TTCAWFiI+ D..P.i,AAN CHECK
$5,909,81
LESS PRE-i'/ai:l)'413E
-M.00.:
REC IPT /
DAT.#'
1 BYf },r,, 7,e,(
,15ATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade _6 (!r
Return Air
Steel &14_
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
FinalI
100�0) —lit 916
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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
Encapsulation
Gas Piping
Gas Test (o (h
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 0-- Y 97
Utility Notice (Perm)
COMMENTS:
,
qeq --v�LI
I
Buildi
OwneA%`,,
i /lf1 S tom'
Mailing X,
Address
.✓
ress
P.O. BOX 1504 APPLICATION ONLY
` 78-105 CALLE ESTADO
®LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONN�
STT..� n OCC.. GRP.
6
Number ! - 216
V�L gal Description 47l
y Project Description
City IZip I Tel.
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer ,
Tel.
—1
Citvr— V IZi
..�AeCA.Veo I 41_ . .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 thathe 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 (5500).
Ill 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, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
tl I am exempt under Sec. B. 8 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
r7 Copy is filed with the city. [3 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 Address
City, State, Zip
BUILDING DIVISION
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL Z • O
REMARKS
AMOUNT
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
FINAL DATE
Issued by:_
Validated t
Validation:
INSPECTOR
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. 8 $
UNITS
1
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
GAS (ROUGH)
METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. @
GROUT
WATER HEATER
WALL SO. FT. @
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ t Y. c
SEWAGE DISPOSAL
SO.FT.GAR Q 3/4c
HOUSE SEWER
FINISH GRADING
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 & 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 APPJEOUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Notice:
Document Cannot Be Duplicated
Date 4/24/96
No. 14374
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 769-550-026
Jurisdiction La Quinta
Owner Name Minstrelli Construction
No. 79065 Street Coyote Creek
City La Quinta zip 92253
Tract # 26152
Type of Development
Comments
Lot # 32
Single Family Residence
Permit #
Log #
Study Area 125
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.
Fees Paid By Ministrelli-Painted Cove, Inc. Telephoni, 564-1849
Name on the check
J'
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Payment Received
Check No. 2506
SignaturePAAA.�. I
$628.00
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
(�Zvt
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WIN
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Ttot�r'Vf 14a.(Quinta ' ' -
�uildin� end �s�fet�r �iui�i�n
This Certificate issued pursuant to the requirements of Section 306 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 79-065 COYOTE CREEK
Use Classification SINGLE FAMILY DWELLING Bldg. Permit No. 9604-034
Group R 3 Type Construction VN Fire Zone Use Zone R 3
Owner of Building MTNTSTRF.T.T.T Address SAMF. AS ARnVF.
Citv LA QUINTA
Building Official
By; KTRK KTRKT,ANT)
Date: 10-22-96
IN A OONeVICUOU! PLACE
III