9707-060 (SFD)LICENSED CONTRACTOR DECLARATION
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
Date 9 - I `t Signature of Contractor `f
I
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.,
( ) 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.
()Q 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.
i'r XM �.f14 5 % �C3 ; -v .31
(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
tDate:
ode, I shall forthwith comply with those provisions.— r 7, .17 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
application. t
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 commencediwithin 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
iw the above-mentioned property for inspection purposes.
Signature (Owner/Agent) - -+� Date e-
BUILDING PERMIT PERMIT# CONTROL#
5 7 4 4
�S.1wU
DATE 411jj!9'7 VALUATION-,23QJQ,()9 LOT (�'� TRACTJOB
SITE
ADDRESS 79-140JACK RAU RIi TRAIL
APN 769.541 -Il iii
OWNER
CONTRACTOR / DESIGNER / ENGINEER
-5044 4; MC,1JN'I`JUN ;S.FUi h WS Ria
50445 Mt3UN t',AIN SHADOWS RD
9,ti, QU19VA CAS 4225:
LA (?WNTA C A 9253
f'Ttif!)5 4-t ib ' C1i�t, .M25
USE OF PERMIT
i'ia�l.!ti. Gvti: Nei i?vt��s; �z [I%.irC`l�: Wr'�i,L e iR I'C+C,iy. r EFTS Rr ECT '
Af8ART) N P(JB},:i.C: ALACES CREDFI,OF MO 5,36, Pik iacl!'�.ttt' .sa VC1 W1
tt: +y NIUNi.? Y NEV. DEPT.
TU AE'T C0,N311 W t�+
8.11!) :iJA°
MIT11WTV-0 COST 01061
P4 IM.i'IT PEP, S[rf4We' M`
:0NSTI I.Jt.;i'iiCNFEH EQf..k.-i(��!(v�� 4E.i8-ft)) $t,tP3lf.tA3
%J.A N f, lit --6,-K T30- t 01.0041-;f,d1).110 ',V�
!�ilc::i:IAiv.�.�,.l.�lfs dfaJ-Dtk}��21.-13111? Sl17.5t!
+.:faizfy�'�t.lc';4.f.:frEE'1 {tll.•C)UU>�2(i�i)Uti - $:;•1v.>fM
i�i,f'tl4fii{tWs Fah'!' 911!«t!!#()t�1t�-Rfll� t,T+jt �^,4
.Xok4G, ,�ttr{'.t: e t; 11, . 1101-00.114140 . �= 411
r0i_'Ii 2125 -OM -443-342 $5.0554._%i
ART IN 1%116,11.111 P1 4M,,S.A - j+'{ASN, 7PI
aa .V IR 1\S C/ { q ." 1Y slt
.!!Z! 4t'} I }1QaL,�4. Y�{e71F�SIJ - Rwt:.al1.,.
60
,fns �.4 AND PF -AN c' 14VOt�'
Aa�
e �g91 .LESS FEF's
4575—Vi
3-3
01•0Fr ':fit 3W
$7;516,1.77
/
RECEIPT
DATE
By, o
DATE FINALED
INSPECTOR
.--_
INSPECTION RECORD
011',.
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 Q-
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 lAtlf
Final
Final
BLOCKWALL APPROVALS
Steet>
POOLS - SPAS
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 -7--g-T-Heater
Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Connection - -
Encapsulation
'CladPiping
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:
Tfrw•�o Ln l 2
F �', v'� 6 %�
_ s CITY OF I0rl 00TA QUIm
BUILDING & SAFETY DEPARTMENT
777-7012p' Ir 1� 1997
INSPECTION REQAL44
777-7153
FINANCE DEPT.
Owner MINISTRELLI-PAINTED COVE INC
Contractor MINISTRELLI-PAINTED COVE INC
Permit Number 9707-060
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-140 JACK RABBIT TRAIL
i
SFD - PERMIT DOES NOT INCLUDE BLOCK
WALLS OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK 7 -
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
/CAj,7-2-i,,') 7—
()0 N
DON POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF O -
BOND BEAM
O.K. TO WRAP 16 k Z/_
01
GROUT O 4' ❑ 8'
FRAMING
INSULATION S<�1
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIG ED
DRYWALL INTERIOR (,)Z77 K1, 7
EXTERIOR LATH _ l
POOL PRE PLASTER
PPRL,kENCE & GATE
"SEWIEWSEPTIC TANK
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Building
Address
Owner "
�We/!.okly
Mailing
Address �Q
city?
�.,;�
Contractor
>V OALA
Address _ —
State Lic.
& Classif.
Arch., Engr.,
Designer
p
4a"
BOX 1504
ALLE TAMPICO
CALIFORNIA 92253
9�0�- o('0
APPLICATION ONLY
r~�� UILDING: TYPE CONST.le 0 OCC. GRP.
rl►P+L �% �sP. Number
9 Tele _ 4'&n „ �2- q - 5J29
� Zegal Description
�, Project Description
City�j
Lic. # .0 E2
Address
7/_r14;—
ddr ss4;— ,- / f, - Tel.
r It; Zip State
1c ` 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. I
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).
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
orimprovement 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.)
H 1, 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.)
0 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 I
f-1 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 thF 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 I
NOTICE TO APPLICANT: If, alter 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.
I
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
- A . . n i
3timated 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
4
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY f
Side Street Setback from Center Line
—
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.) Side Setback from Property Line
Lender's Name I` �f' j �,•
Lenders Address ' FI'NA1 DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to .
expiration it work thereunder is suspended for 180 days.
6.0
I certify that I have read this application and state that the above information is correct. SSUed bye Date Permit
I agree to comply with all city and county ordinances and state laws relating to building �'✓ y
construction, and hereby authorize representatives -of this city to enter the above-•, Validated by: . II I I 1997
mentioned property for inspection purposes. L ;; i ;•
Signature of aQplicant Date
Mailing Address 'Validation:
City, State, Zip t! 6 Y ,0�—'
4
WHITE= FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Notice: s
Document Cannot Be Duplicated
)
i
Date 4/24/96
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 769-542-018
No. 14375 Jurisdiction La Quinta
f
Owner Name Minstrelli-Painted Cove, Inc.
No. 791401 Street Jack Rabbit Trail
City La Quinta zip 92253
Tract # Lot #
Type of Development; Single Family Residence
Comments
w
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.�'�
:Telephone 564-18 r9
Name on the check
c4 r 7,.
By Dr. Carol McGrew J% s
Administrator in Charge
Fee collected /exempted by Pauline Pearson Payment Received S628.00
I.
Check No. 2503
Signature PftL-,1 I'* l 1 11, RoAt w A AM,
NOTICE: Effective January 1, 1997, 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 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 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- Buildinig Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
l '
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:
Use Classification: SFD
Occupancy Group: R3
79-140 JACKRABBIT TR
Bldg. Permit No.: 9711-073
Type of Construction: VN . Land Use Zone: RL
Owner of Building: .MINISTRELLI CONST
Building Official
50-445 MOUNTAIN SHADOWS
I POST IN A CONSPICUOUS PLACE I