9512-067 (SFD)- LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
c -)License is In full aneffect.
� O
u-)Licensefd
691899 B '• IS/31��1b
�
L License # Lic. Class Exp. Date
r• r` Date f... ignatureof Contractor
O
co H 0) OWNER -BUILDER DECLARATION
J W 1 hereby affirm that I am -exempt from the Contractor's License Law for the
CL 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).
( ) I am exempt under Section B&P.C. for this reason
Cl)
Date Signatureof Owner
N
O rn WORKER'S COMPENSATION DECLARATION
aQ I hereby affirm under penalty of perjury one of the following declarations:
g Z ( ) I have and will maintain a certificate of consent to self -insure for workers'
LO FQ- O compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL performance of the work for which this permit is issued.
OJ J () I have and will maintain workers' compensation insurance, as required by
m Q U Section 3700 of the Labor Code, for the performance of the work for which this
p U permit is issued. My workers' compensation insurance carrier & policy no. are:;
CL rn Carrier' Policy No.
IC? Z (This section need not be completed if the permit valuation is for $100.00 or less).
� O () I ceArtihty�tlthjt in,,�e performance of the work for whi, t�lthys��9Mm tlis issued,
Q 1 shall not employ any person in any manner so as to ` ecome 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
0 Code, I shall forthwith comply with those provisions.
Date: 7 2,.4,Ap plicant '�. /) �" � -
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.
1 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
44
whose request and for whose benefit work is performed under or pursuant to
any•permit issued as a result of this application agrees to, & shall, indemnify,
& hold harmless the City of Indian Wells, its officers, agents and employees%
2. Any permit issued as a result of this application becomes null and void �f
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above informon
correct. I agree to comply with all City, and State laws relating to the b.i
construction, and hereby authorize representatives of this City to enter upo
• above-mentioned property for inspection purposes.
Signature (Owner/Agent) y/ Date
"""BUILDING
PERMIT
PERMITi
v5112 -4I67
DATE
VALUATION 5'2()0,796,1.11 LOT 40
TRACT 25429
JOB SITE ADDRESS
79-M C'OYO'TE C'RFrK
APN
769-55dP-f)J5
OWNER
CONTRACTOR
1vi1NlS°'1'R.ENI.t TAT)V I'E'D COVE,
MMI S'TFIEI LI -PAINTED COOT,
'50,145 IMO N1 AI.N SHADOWS 121
50445 MOUNTAM MOMS RD
LA QUINTA CA 922..53
LA Oi3is`TA CA 92253
(619),A-1849 CBL## 3625
DESIGNER/ENGINEER
(619)%64-19d9
USE OFPERMIT;INGLE, 1;_AMILYDWELLING
Ponnit doeA nol include block: whit or pool_
Aare In. Public Places zem balwe reffix:ts a 251,99 cmitit ;Per
L V FEE DESCRIKION�y
FEES
~ TRAt:"t' CONSTRUCTION 3,375.00 SF
.PORC—MIATIO 300.00 SF
CARACWCARPORT 691,04 StV
SMAT1) COSTOF CONSTRUCTION
24M),7V6.10
�
T-ERg6IlKSXff A*k1
PLAN CMC,`K F -S 101.000-439-318 5845,17
CONS MUCTION FEE 1.01-000-418.000 $993.00
1VIf;C.i ANICA€. FEE 101-000-421-000 $1313.50
F_LW_- PJCAL FEE 101-000-420-{)t3() $223.45
PLUMBING FEE 101-COO4-19-000 $186.75
S'I'0`NG MOT1014 MY, - REM 100-000.241-000 $20.09
GRA13.1N0 F 17B 101.000-423-00O $20.00
INFR kSTl1.i7C7'CIJI' E FEE ''225-000-443-342 $4,428.14
�
,
r° �Su. - i'A:L CoASrRIIcT14N.AN.0 PLAN i1•°j:1sCK
f6,847.09
LESS 1'T1- -I' iD KES
42-50.00
JAN 10
1996 'CO's' L T'E3tN'T.t"T' F' MIS DT1E NOW
56,.597.09
ti
f
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings47
IOU<
Ducts
Slab Grade
- (fC
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
—
F.A.U.
Framing
(/,C.
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
Final1,46
;Z?- L
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Q 2 w I 1AX
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
72T7
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 6
Address ;W (�'�el-10,
Q
Owner
Mailing
ss
Address <�
Ci �C!!it-/rte ZI�i�L.
Contractor
Address
City Zip
State Lic.
& Classif.
ArchDesigner /
Desi nerer
T4'yl
P.O. BOX 1504 APPLICATION ONLY
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
e- OtAt�-'P .
Tel. Y
Tel.
City
Lic. #
Tel. 71 W
Zi 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 Bu iness and Professio ode, and y license is in full fo�&e a d
effect. �� `�� yr j� // 10
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 or Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty or not more than five hundred dollars (3500).
I : 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose or sale.)
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
r] 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 9 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: If, after making this Certificate or 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
BUILDING: TYPE CONST. t!540 OCC. GRP.
A.P. Number 1F�70 — 0 3 5
Legal Description
Project Description`/� !—�a,+t'r�,.� ��r!-•�s",r�
i r
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft.
Size
No. j No. Dw. '
Stories f Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback fibm,Center Line
Side Setback from'Pfropert Llne—
J
FINAL DATE
INSPECTOR
Estimated Valuation
Issued by:
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Validation:
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
7 �' • (J� .�
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback fibm,Center Line
Side Setback from'Pfropert Llne—
J
FINAL DATE
INSPECTOR
Datil it
Issued by:
Perm
Validated by:
L/�
Validation:
\
CONSTRUCTION ESTIMATE
NO, ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. @ $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
GAR. SQ. FT, @
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT, &i)
GAS (ROUGH)
WALL SO. FT, @
DRINKING FOUNTAIN
SQ. FT. @
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
REMARKS:
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE.
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.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 APPJEQUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SiGNATURESIINITIALS
GARDEN WALL FINAL
Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
CERTIFICATE OF COMPLIANCE
Date 12/21/95
No. 13970
Owner NameMinistrelli Construction
No. 79-200
City La Quinta
Tract #
Type of Development
Comments
By
Street Coyote Creek
Lot #
Single Family Residence
APN # 769-550-035
Jurisdiction La Quinta
zip 92253
Permit #
Log #
Study Area 125
Square Footage I
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:
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 By Ministrelli-Painted Cove, Inc.
Name on the check
Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Ellen Patino
Signature� IA(��
Telephone
Payment Received $628.00
Check No. 2092
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
711
_W vA
�gzlrt
.01 Orr - -,�
:xij�!�
,1
TiN. of 14a I
�ilt��1E13i%tt1ln
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. 79-200 COYOYTE CREEK
Use Classification SINGLE FAMILY DWELLING Bldg. Permit No. 9512-067
Group R3 Type Construction VN Fire Zone Use Zone R3
Owner of Building MINTSTRELLT Address RAMR AS -ARO UR
City LA QUINTA
By; KTRK KTRKT.ANn
Dote: 10-22-96
BifilTinj OfflCla POST IN A CONSPICUOUS PLACE
_;--t .
tin
r
ESI/FME, Inc.
® STRUCTURAL ENGINEERS & CONSULTANTS
SINCE 1974'
PLAN CHECK REPLY
PLAN CHECK BY THE CITY OF LA QUINTA DATE Jan. 4, 1996
PROJECT NO: 194-6225-9
PROJECT : "PAINTED COVE"— LA QUINTA CLIENT NO BBG 124-0100
DEVELOPER: MINISTRELLI CONSTRUCTION FILE NO 6225P1 PC
La Quinta, California SHEET NO 1 OF 1
ARCHITECT: BBG ARCHITECTS, INC.
REGARDING: PLAN CHECK FOR PLAN 1 C AT 79-200 COYOTE CREEK
PLAN CHECK NO. 9512-067;
ITEMS FROM PLAN CHECK CORRECTION LIST
ITEM PL SHT REPLY
SECTION H
3 We, as project engineer of record, will stamp the truss calculations with
our shop drawing stamp indicating reviewed when they are approved in
our office in accordance with our design intent.
Truss "72". does not require drag loads.
ISSUED BY: COPIES TO:
ESI /FME INC. (3) BBG ARCHITECTS, INC.
STRUCTURAL E/yAEk-ES Attn: Jim Deford
mm
for ES
1921 EAST CARNEGIE AVENUE, SUITE W - SANTA ANA, CALIFORNIA 92705 • (714) 261-1811 • FAX (714) 261-8506