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9701-111 (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--,%, Signature of Contractor;2– OWNER-BUILDER 2 -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. • Ciltt:�7"'1�..A�1'Ja�ju. 'ot'te45;3"sli3� . (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 370005f the Labor 'ode, I shall forthwith comply with those provisions. Date: /f� �>7" Applicant— Warning: Failure to secure.Wobers' Compensation coverage is unlawful and shall subject an employer to criminal'penalties and.civil.fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building acid Safety for a permit subject to the conditions and restrictions set -forth on ,his application. 1. Each person upon whose behalf this application is made & each person at whose request and -for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall,:indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null' and void if work is not commenced within 180 days from date of issuance of -such permit; or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives R!ethis City to' enter upon th /above-mentionedproperty for inspectionsles. �,. .. pis. (Owne PERMIT # CONTROL # BUILDING PERMIT �lia.�. 4696 DATE VALUATION �' ���y5�. LOT TRACT JOB SITE , -ADDRESS 50-240.10NDIAIN CAMP ROAD APN 769--542-032 OWNER CONTRACTOR / DESIGNER / ENGINEER WIC. COVEV :'01C. 50145 MGA:m!'MIN SHAMMS W 5044i i IOUN'P:&IN S14ADOWS Cif.`) LA QfAKrA (.,A 91215; LA (XIIN'T'A CA 92253 C (c�I!�)SC�i�f,i lti Cuff lm.s USE OF PERMIT SPIT Sv'oa v ft w "f;7OHS NOTINCLUDE, 11LOC9 WALL Obi PO L. Iaf:R&1I T Fh. S Itis.f+`Lf C r AN AWI',� IN PUBLIC PLACES C RIEDIT OF 230.96 .PER, Akil$MZQ..N'f.' W..11 fl t 0M141[1I.J Y 1DEVrILC+kPIYiL'NT. AC7 00N`: .':itc1CT_'lON• da*',00 m. i+t�If�;f�st�b�l'.t:iU 4a0.011 kf' Cft�fi�1l�lfllr'##{.1'i„iR'1 " `•. 4fa'�.OU �Ir � lLtl.i.ATE, 1) CUST '4.1'F ICONS Y Av.i.J i-`f•A6.71 V M.�aL'�tlPY'•s�18 ..�F3yni 31°Tiih1�l.l �• .�J !J � 113 LZ'�AO�L'A/.�.'.�y f `'C?�dS`f fta�t'..°l'iCa�t "Fkil: 3 ®1 ft(i0�/f t tt-(i(i(J S��f � +t(f r ""��•. t•+), a1-3� �;141�Cf~. a+t en, 1:f11-ff�-��'�g� 1.?i �ia3•`? K t trr, YA 1'f'3WT 4250100 i l A4r " .RAte ICAt.: t L -"g `10t.-000-421-000 $105100 �:c f=c cfucA�, FFI 1,01-000 1, 0�t)0 $2 443 , rn KJJM'3tN0 PM IOt f){i`!y4t!�-(#3t3 S^��.tlJ s "vr,. � C" � ;.,n.:R 4& -yt,f:ki"t.i§�3 A. ierJW�'�:�b.^^t.�,t.Wlla MAf)f Nt l t?fes f 01 fOSj- [-f Dif $�'i�,tit) t4 `f.' t.N til fsiiatr� fsa At s p H.t: elr "I(f t QC1t1 5,5-f}()0 � x.98 �+ LLJ ART d.; t 4rU.lt;~;4 f t.Af'):S-1701:,t1,S].1000.255,000 -=406 L. 81M. -TOTAL CONS IRUf"HON AND PL Ali .CIRECK ,,. LESS PRE -'AID C�Ff a" ���f1Z0 f5 TOTALPE14MIT FEES VVE, NTOW $6,R)9,63 P/ RECEIPT DATE BY DATE FINALED INSPECTOR +ro".40 p INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footinds 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 Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . 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 Appliances Final COMMENTS: , Y r 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) PBuildingc Addressss Mailing Address �Q City9 Contractor Address City P.O. BOX 1504 78-105 CALLS EST ADO f_)1_A QUINTA„CAL-IFORNIA 92253 APPLICATION ONLY. i ss ` BUILDING: TYPE CONST.__S1r)0. OCC. GRP: ,v I'll A.P. Number � S e V� , 7e� Legal Description ._ Project Description lop r p -el. State Lic. City & Classif� Lic. # Arch., (_+,� Designererle AlAl�r Ily I State 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, andimy 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 slruc6rre, 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 eAempt 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 collars ($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 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.) 1,1 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 Contractors License Law.) 17 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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 17 Copy is filed with the city. D Certified copy is hereby tlrnished. 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 thi: permit is issued, I shall not employ any person in any manner so as to become subject tc the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: 11, after making this Certificate of Ecemption 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 AGENC' 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 it 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 ste.te laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Sq. Ft. No. No. Dw. Size Stories Units I New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 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 INSPECTOR Issued by: Date Permit Validated by: Validation: JAN 16 1997 BU LDING DIVISION I CITY OF LA QUINT) 23or�' Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. �5�1 • `� 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 Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: JAN 16 1997 BU LDING DIVISION I CITY OF LA QUINT) CONSTRUCTION ESTIMATE SO. FT. @ $ NO, ELECTRICAL FEES UNITS NO. PLUMBING FEc 1ST FL. 2ND FL. POR. GAR. CAR P. WALL ESTIMATED CONSTRUCTION SO. FT, @ ROUGH PLUMB, YARD SPKLR SYSTEM SO. FT. a MOBILEHOME SVC. BAR SINK S0, FT, @ POWER OUTLET ROOF DRAINS S0. FT. UD DRAINAGE PIPING SO. FT. @ DRINKING FOUNTAIN SO. FT. @ URINAL VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation GAS (FINAL) FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER BOND BEAM GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRYTRAY 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 SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1,/a c SEWAGE DISPOSAL SO.FT.GAR @i 3/c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE 7ONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRbC�AL 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 APP.IEOUIP. 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 2/10/97 No. 15249 Desert' ands Unified School District 82-879 Highway 111 Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Owner Name Ministrelli Construction No. 50240 City La Quinta Tract # Street Indian Camp Lot # APN # 769-542-032-2 Jurisdiction La Quinta zip 92253 Permit # Log # Study Area 125 Square Footage 1 Type of Development Single Family Residence No. of Units 1 Comments irandtdthered 3087 sq. 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 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 cc/First Community Bank/Ministrelli, Telephoner 564-17849r Name on the check 57 By Dr. Carol McGrew Administrator in Charge f '• �., Fee collected /exempted by Pauline Pearson Payment Received r $628!OJ`.-� i Nom` Check No. 70614 4 Signature Qy� i 1 o n� U 1 I ,A) A A' ,/lti 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 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 ollect 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 a Q�` CIT/.6F LA'QUINTA DING & SAFETY DEPARTMENT I CTION REQUEST LINE Q 777-7153 Owner �PNIINISTRELLI - PAINTED COVE Contractor NUNISTRELLI - PAINTED COVE Permit Number 9701-111 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 50-240 INDIAN CAMP RD. SFD - PERMIT DOES NOT INCLUDE BLOCK WALLS OR POOL TYPE OF INSPECTION DATE I INSP. FOUNDATION & SETBACK MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED COVER NO WORK UNTIL ABOVE HAS BEEN SIGN D DRYWALL INTERIOR - 7) EXTERIOR LATH / POOL PRE PLASTER ENCE & GATE SEWEFj SEPTIC TANK -2/• 1 FINALS "uubt NUMBERS JOB COMPLETED j TEMP PnWFA I f T a ABOVE APPROVALS DO NOT INCLUDE RIGHT TO 7/96- TURN ON UTILITIES OR OCCUPY BUILDING