9803-152 (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
6:131,99 --7 W11198
Date��T,�zG 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:
( ) 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, 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.
S T'A,`!TF.1'"f 111W tib+- #i -i3 6923,
(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 thosOprovisions. / I
,/Date: 10 -'?T At Applicant -,r
Warning: Failure to secure Workerstompensation 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 represedntatives of this City to enter upon
the/above-mentioned property
'f000r inspection purposes. t
Signature (Owner/Agent)^ /mow'Date✓ 77 4i
j`" l..t
BUILDINGPERMIT PERMIT CONTROLJf
803-1.52
DATE VALUATION LOT TRACT
699 0
H - 3
JOB SITE' I
ADDRESS 50.200 T.NDTAIN CAMP ACIAD
APN 0-54/-031
OWNER
CONTRACTOR/DESIGNER/ENGINEER
$Rri\rh73) nr 00",T t+rI.
+s1w1„d, .F`c..1av iti,IRw.�
D IIHTTINC.
9»:.
-V445 MOUNTAIN S..14A BOWS RD
504,45 MOW AINT SHA.13tDW',R KD
LAQtJI TA. CA r';L53
1,1A.Q1JlM,A: CA 92253
f7ci0 5S.9-I$�i<> Cf#L.4 _1625
USE OF PERMIT
Sr -D •• saERNFIT DOES'NOT INCLUDE BLOCK WMUS O1 PX& M(T IN
PUBLIC lE'l..,t'vd:E 3 G.[WIT OF S262.1.1 t1PPLMD :.-REP, Afi;liEEMEN11' W111i
com"K OEV. DELY,r.
j CO '- I .I'. f 3 1"11 i {1 Y�
�F�C� �.lJi��7iit:tf�,�IO'LV ,3,`f,9�.�1! at
PORCHWA110 31a.c* a
GARAGWCAR-PO RT 708.00 tiF
kr':.Si["9i4YUMIM COSat ov CaNwratu k'" o'N
�'T�dit�tT• �`t'1'r �8.fii�'1��i'�`
�_
CO143THLUC710N:PIPE 101-000-418J"
pl_& ? C3 WICK FE
-1112;7t3T0S14250.00
3,+ ECCIANIC AL ES 5130.
aECTRX'AL FER 101-000-120-M 5207.03
: i��t••`yy�,�`�ylNC�Y M -,=IV 104-000q�€r�}-u��}t1-01n1(0� 2o.41S
I�vlrr'�»»'VIeON
420.0.0
1N1+'"RASTRULT(.}iEME 225-E1{ifi-443.342 seg$.A.t.3
ARS' IN PtJR1JC f'I<ACjCR �RE-Sii, 701 x(3€3-�?�yS?Oi1 32F)i. d 1
ART, wd 1113BLIC PLACES - gL; ,%G 701-000-255.OUO
Il
3�
I .�'1ti CONST-drallW"WA`�19�•�LAN C HECK
LESS P.> -PAIDF S
45412,11
APR 2: 1998:t�:+'.�$0f_�;®NNrta,79fa.
JiTY OF LA QUINTA'.
RECEIPT ..
DATE
B1?_
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs —r .,
Underground Ducts
Forms & Footings5 - (_
Ducts
.Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Flaming
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 f .�
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 7,
Pool Cover
Sewer Connection
Encapsulation
Gas Piping ,
Gas Test
Appliances
Final
COMMENTS:
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
Rnal
Wily Notice (Perm) - 2
-.y,-+x�t'�.++..v rs�y��.`{'p ^^P�-Y �-�'j,---i-n-.-K ,--'::a..y,�t.;,�,r»�-y,k�`,`"1F�•f�il�'.:-j+i1M'1��.?'.�i�'�'laa+'{�+q�i7l�%;Tr.*%`�o�+v"aM.��,i<`•�'i'
�Cu vC eit y / at .0 �t_°
P.O. BOX 1504 APPLICATION ONLY
Buildingq 78-495 CALLE TAMPICO
Address Oa��DNOiRr�/C./� 4/+� /rA. LAQUINTA,CALIFORNIA 92253O3—
Owner'
/'1%/Nl5
BUILDING: TYPE CONST. OCC. GRP.
Mailing n/
Address SQ /y5� 01J7'.A1N Sd1146� A.P. Number ! 6 1 -5 `42 0 3
City Zip Tel Le p f 0'7` / 7
city/,q
Tell S.3 � 6 41`_-/g, yc� gal Descri tion .
Contractor n Project Description
Address
Tel.
State Lic.GQ
& Classif.
�3 7 -!
City
Lic. # 36 AS
Arch.,
Designer
Address
A L— 3 L -Q ,0-- ,
Tel.
City P Zi Sta:e
Lic- #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 r-ommencing 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 'ie is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencng with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exemll therefrom, and the basis
for .thealleged exemption. Any violation of Section 7031.5 by 'aiy 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 theiP 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 :n owner of property who
builds or improves thereon and who does such work himself or though 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 -bolder will have the burden
of proving that he did not build orimprove for the purpose of sale.)
IA 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 no 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 DECLARATIGN
WorkeI hereby affirm that I have a certificate of consent to self -insure, or a certificate of
r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
"F] 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 hundlEJ dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this Delimit 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: It, 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 val dated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 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 adplicant Date
Mailing Address
City, State, Zip
"'.1 .
Sq. Ft. 3 1 l3
J `
No. No. Dw.
Size
Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
SMS-
A L— 3 L -Q ,0-- ,
5-d125-140 uN%If, Al SA11f 4 o&uJ s
`7-
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Cj(a
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
3 1
Issued by:
Date Permit
Validated by:
Validation:
PM
WHITE= FINANCE YELLOW = APPLICANT
PINK = BUILDING DIVISION
MAR 10 1998
r%rr v e%c 1 ! rm l&ACf
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 4/1/98 APN # 769-542-031
No. 16841 Jurisdiction La Quinta
Owner NameMinistrelli-Painted Cove, Inc. Permit #
No. 50-200 Street Indian Camp Road
City La Quinta zip 92253
Tract #
Lot # T7
Type of Development Single Family Residence
Comments
Log #
Study Area
Square Footage I
Urandfathered property - imstre i- alnteCove, Inc., 3,43 9 sq. ft.
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 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 Cashier Check/Ministrelli-Painted Cove, Inc. Telephone 564-1849
Name on the check �.
By Dr. Doris Wilson
Superintendent
`rF�flll�
Fee collected /exempted by Juanita Green Payment Received $628.00
Check No. 078419
Signature
NOTICE: Pursuant of A%4embly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 913 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the dale 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- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
e<
ESI / F M E , Inc. RECEIVED JUN 2 2 in
STRUCTURAL ENGINEERS & CONSUETANTS
e
FIELD
REPORT
SITE VISIT NO.:
0 N E
DATE
June 17,1998
' PROJECT NO
194-6225 -
PROJECT:
PAINTED COVE - PLAN 1, LOT
77 CLIENT NO:
BBG
BUILDER
MINISTRELLI CONSTRUCTION
FILE NO :
FRPl LQ77
LOCATION:
La Quinta, California
SHEET NO :
1 OF 3
ARCHITECT:
BBG ARCHITECTS
ATTENTION:
Brian with Ministrelli
PROJECT SUMMARY
SITE Single Family house is situated in a developed area.
Field Observation on June 12, 1998
FIELD OBSERVATION
The following structural items were observed and need to be addressed:
For location and clarification of items, refer to photo reduction of framing
plan on following sheet.
ITEM
Garage and Service Room:
1. Over Garage: Provide 1x catwalk at hip trusses per truss calculations.
2 Provide Simpson A35F on each side at one end of man door header where trimmer is
not resting on mudsill and provide shim under trimmer at other end of header.
BEDROOM #2 AND BEDROOM #3
3 Provide Simpson RFB#4X10 with Simpson SET epoxy tie embedded 4 1/4"
into first pour for missing anchor bolts per ICBO#ER-5279 at Rear of Bedroom #3
4 Provide 4x4 post under 3 1/2" x 11 7/8" PARALLAM BM at rear of BR#2.
5 Shear wall at Rear of BR#2 bathroom: Provide Simpson LS50 @ 8" o.c. per Detail
E1/SD3 and add 3/8" plywood with 8d nails at 3" o.c. ( Shear wall #12) due to the use
of 3/8" plywood on other side in lieu of 1/2" plywood per plan. Be sure to align adjoining
plywood panels over 3x stud, when adding the new 3/8" plywood. Add stud on each side
of existing stud where existing plywood panels are spliced. Nail each new stud to
existing stud with 16d nails at 4" o.c. and shear nail each panel to each new stud.
FAMILY ROOM KITCHEN NOOK DINING ROOM AND LIVING ROOM
6 Provide Simpson ST22 from beam to post at Family Room.
7 Front of Entry: Provide (4) 3/8" dia. x 6" long lag bolts from drag truss to 3x block, since
A35's were _ not used per Detail Al /S D3.
1921 E. CARNEGIE AVE., UNIT 3—J, SANTA ANA, CA 92705 ° Ph. ( 714) 261 — 1811 / FAX ( 714) 261-8506