9809-067 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed `3rtder'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
693899 B
AY'
ate "^��" �� Signature of Contractor F= `� ?,
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.
S s r1`f'.T ,FL„D (e154 ,343(!t •M
.(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
sub'' 6 to the workers' compensation 9rovisions.of Section 3700 of the Labor
Code, Ishall 4forthwith comply: with Ethos provi io s —-
Ate: Applicant _
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 fo the conditions and restrictions set forth on his
application. a
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.
BSignature (Owner/Agent)`'<' Date`
BUILDING PERMIT'PERMI�CONTROpL#
e�
DATE / VALUATION S A5,547J0 LOT ]( TRACT i q o
V-.
C(v 6a V 1
JOB SITE
ADDRESS :'fit -11110 INULAN CAMP ROM)
APN7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
h9INMR, T!.L,L [-PRANI ED C E, IMC.
74735 F.MY 131 S :C'T; .105 1
747851-f 1 -MY 11 f. S'i E i 05
INDIAN iall?I.aLS CA 92210
1,JN1.A kN tiV€:L:f_,S CA. 9,2210
(700)776-4450 CRL# 1625
USE OF PERMIT
"NOLE F1o.,MILY L•)WEEL1..ING
Soo - P�tttiv IT DOES N -OT 1NCLLrD4'.BL0C`1a V%rALLy OR POOL.
k1tlRAGG(r el daiir^x.')' 359.00 Si
f�t�itt f1l1'A.i.i 440.00 SF
L iAt:':t` C:tJAIS'11i(14:3'f;72rt 3,073.00 sir
VEMMIT VREP aSUMMAIR
FE :t3:RKIISIT 10JI-M439-318 4250.00
PT,ANr,%:C 1F K 10H.W-439-31St 1$90€171
CONS TRUr".'TION FE -13 101-000-415.000 $9.1.0.50
MECH► MCAL i -TI -1 101.000-121-000 S115,50
JELE'C".MCAL PEE 101.000-420-000 S214.2A,
T.i:f1?F3rtrrr Feg 1 C11 -000-419-0M,
MONO lVOTION rt- - RF,31D 101-000-24.1-000
t . M'O FM 10.1-000-423-000
1I41: P.AS' R tJC'"1' IRE FEF 225,M)-443.342 5,3,0fi9,1 r
Px. V 01 PUBLK, rTIACT S - REV, 701"000-255-000 S21 i.99
5€.,1R-?'f:111.r lr�t5?3C? r(�.►*i AND »i.}11i1�iC,}TTylB;tc
FEES
PA,
PI
42150,00
T a'A1. &'1f��troff V C 1D� 9+, NOW' .
$6.345.91
OCT 2 6 1998
CITY OF LA L��TA �.
RECEIPT
I DATE
BY',
i#
DATE FINALED
INSPECTOR
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ _
_,or 99 �`�
Compressor
Insulation
—19_ �/ /2f�
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALSGas
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
, / ,yy
/
Pool Cover
Sewer Connection
7'— `�
Encapsulation
Gas Piping
Gas Test
�rr�
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
r
Final2'���
_
Utility Notice (Perm)
r jAddr 0 ing
" Address (0 6
Owner N/N/: 1074
Mailing
Address
City
Contractor
ress
y,.-,yj: • � �s>{- res`=.'x�,.�.,:u�TvMW�iiWP'�,,jFb"sr'"7::'rt'%`Pcws�rt*,a;-:,�Sd+:y�;.i.. � f'r'w`t�-. trya•'a,= o�'-`-y=�:,�....+.r`a:,�r-.: vrv�"'
1�Gl�► V� �
"Oct
P.O. BOX 1504 APPLICATION ONLY
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
`161 BUILDING: TYPE'/CONST. OCC. GRP.
K411 /// JU S r -E" /05�, A.P. Number
01 1 Zip Tel - /
1 Z Z /Q �U _ L��iSU Legal Description h -DT-
Project Description SF' i
City lZip
State Lic. City
& Classif. �% G, � Lic. # 36 0
Arch., Engr.,
Desi9 R,
Designer
Address
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions -of Chapter 9 (commencing with Sectlon
7000) of Division 3 of the Business and Professions Codn, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION r
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Ary 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 (hat 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 penally of not more than five hundred dollars ($500).
1.: 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 offerec 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 sae.)
'1'.l 1, as owner of'lhe 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 imprnves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Conractor's License Law.)
1-1 1 am exempt under Sec. _ B. & P.C. for thin reason
Date f 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
f7 Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTIOR FROM
WORKERS' COMPENSATION IN3URANCE
(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 AC ENCY
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.
1 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 ,i r
d
1
Sq. Ft._?o
Size
New ❑
Estimated
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑
Demolition ❑
-Tu 1 C7 aS — 790x6 91C. 96X'V r- ZAI`
7E(K ffoosr i5 A r.,Al P..r Aern l0I-ag*
tic b 1
n
PERMIT AMOUNT
A
Plan Chk. Dep. `%
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
P
4r
TOTAL
REMARKS
R
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line 1
.n Side Setback f Oig P.rope,rt" Line
FINAL DATE
INSPECTOR
Issued by:4t'
lik
D9t'eJ1G11 4t CKQrmit
,-Validated by:
Validation:
4
WHITE = FINANCE YELLOW = APPLICANT PINK BUILDING DIVISION
.Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated - 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 9/11/98
No. .17704
Owner NameMinistrelli-Painted Cove, Inc.
APN # 769-542-030
Jurisdiction La Quinta
No. 50-160 Street ,Camp Road
City La Quinta zip 92253
r
Tract # Lot #
Type of Development " Single Family Residence
Comments
Under Grandfather Agreement 3,073 sq. ft.
Permit #
Log #
Study Area
Square Footage I
No. of Units 1
At the present time, the DesertSands 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:
V
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 tiiay now be issued
Fees Paid By CC/1st Community Bank/Kevin Peters .Telephoe 1776-4450: r
Name on the check r�i
,�,.I
..r Aw !
•" yY
By Dr. Doris Wilson '` t� *",
Superintendent
tri .+,r• r ,,�--
Fee collected /exempted by Juanita Green Payment Received $628.00
Check No. 081678
Signature
INOTICE: Pursuant of Asmbly 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 identifiedabove will begin to run frgfn 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 Districl('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
®pJON TANDY
4 of111T 37630 Medjool Ave.
D 'Palm Desert, CA 92211
EC 1 REQ Office (760) 772-7192
SPECIAL INSPECtION SERVICEFax (760) 772-7193
-
REGISTERED INSPECTOR'S WEEKLY REPORT �iipE�Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION
60-1(,00
Mn v
/ n '
I V 1� IJG : t
REPORT SEOUENCE NO.
TYPE,OF.STRUCTURE ___" - --
��
""' —�
Lo
PERMIT NO.-- - -_ _ -
�
DATE
1a 9
DAV OF WEEK
MATERIAL DESCRIPTION
o x
ARCHITECT
INSPECTORF INSPECTOR
I i
MRS. CHARGED
ENGINEER _ ,w
t5 5� %446
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR I 'inIII ' lr
-
I
SUB
CONTRACTOR A Vik
ObS'E-RVEIJ
a CE%t
E, A. r/9 a Al {p (93 L
Fib
m- sEnct 's-Ifyip5oa
s d ►i
L--71
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
/�rTE
/FR
URE OF REGISTERED INS TOR
-mow 6ZY 7 EPORT REGISTER NUMBER