9809-263 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that) 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
11 693899 B / J 8/31100
/ate l r�. 2 7 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:
( ) 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.
(y) 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 ATC FUND " t�iG-9:v.tDf3itb9
(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 those, provisions:' 7
v6ate: 1 !=/ 1 l Applicant "�A.,d, t' �,•x x� ;`:'
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.
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 abo e -mentioned prope�finspectiofn purp/ose, s.
/Signature (Owner/Agent) 4 �Date
S
BUILDING -PERMIT PERMIT#
98f_i9-2.6:'6
DATE VALUATION % yib2�• � LOT • 75. TRACT _51129
JOB SITE
ADDRESS 50-120 W D.tAN CARIP ROAD
APN
79&_94M29
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'
C N , INC.�.d�S1'
T f..�,r-."t1:i`T�FL' C OVT, INC .
74785 HWY i I I STT,: 105
747851RIVY I I 1 : lqi , 105
I. D)AN WELLS CA 92210
INDIAN WELLS CA. 92.210
(760)7764450 C CIA, 3625
USE OF PERMIT
SINOU PAMILY t %VF,7 i 1N0x
SM » MNUT str+0'NOT .INC'LUME..114LOrv"K WALL OR P001.
TRACT CONS ILti?,.7 1UN 3,439,00 Sr
101X? YPA.TIO 391ZOO S!'
GAR.AGWCA]rtP0FkT Fife
PEJO1`UC V,CE S51i+!ift RY
C ONS MUC:'TION FM 101 -000 -AIR -000 $I,t7itl.S�
1.Aiv'C;IffirK'.FFE
M DLIPL1St i 10)I=adfk;+33r31S =$250,00
N ECHAN1.C1AL ME 101 -000 -421 -WO �I;JXSu
hl. F'C,"I"kiCAL FEB 101-000-42"00 S226.03
S i`ROM ]viii IGN PPE - R .1D 101-M-24 ti400 3'24 %
Cig2.r'WIN0:l 101-000 423-000 rlo.w
.
INfRASTRUC"1'URL•E-FUE 225-0i.*:443t�-341 $4.$13.83
ART ANI' SLIC PL.kCM - REST, 70114 W255 -MO $2,64.57
SM-'?' 'I _AL CGniS 1 R UC;TION AND 1�PiLA,N {►^'�l�Hpt�;pKy
y+j• E
/;0tt
2
T OTAL FERMUT 1' I�+� S OUE r�iOW
S 7,4�"1.78
R 6EIPT Uv
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs "Z-11 -
Underground Ducts
Forms & Footings
Ducts
Slab Grade C
Return Air
Steel
Combustion Air
Roof Deck C
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 z rTPOOLS
- 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
Pool Cover
Sewer Connection C'
Encapsulation
Gas Piping
Gas Test 7 lei
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Paver 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 sj
Utility Notice (Perm)
Notice:
Document Cannot Be Duplicated
Date 12/10/98
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
APN # 769-542-029
No. 18083 Jurisdiction La Quinta
Owner NameMinistrelli - Painted Cove, Inc. Permit #
No. 50-120 Street Indian Camp Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # /f�� Square Footage 1
Type of Development Single Family Residence No. of Units 1
Comments
Grandfathered 3,439 sq. ft.
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 thatybuilding' `
permits and/or Certificates of Occupancy for this square footage in this proposed project n av now bP, issued
Fees Paid By CC/First Community Bank/Kevin Peters a
Tele}�hone X54-149
Name on the check r� i`
A 1n
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Juanita Green Payment Received $628.00
Check No. 082969
Signature
INOTICE: Pursuant of Assembli 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 th 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
tolled them on the Distrid('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
OCT -22-98 THU 03:14 PM MDS'CONSULTING
MDS CONSULTING
PLANNERS . ENGINEERS • SURVEYORS
17320 Redhill Avenue, Suite 350
Irvine, CA.92614
October 22, 1998
FAX NO. 714 251 0516
C.(?, --
Post4e Fax Note
7671 Dare
pages�
To
F -m i7
coJDept.
Co,
Phone a
Phone a
Fax
46,1
Engineering Department
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Rough Grading Verification
La Quinta - Tract 25429
We have checked the area referenced below and find it to be in substantial conformance the approved
rough grading plan -
Lot #
Elev.
As -Built Elev.
Variation
54
45.0
45.1
0.1'
57
46,1
46.1
None
65
47.3
47.3
None
66
48.1
48.1
None
70
50.5
50.4
0.1'
72
49.5
49.5
None
73
47.3
47.3
None
74
47.0
47.0
None
0.1'
46:6��
��46.7
Stanley C. Moles
R.C.E. 20596
Expires 9/30/01
G:\307W4\cer-r\54.57.65.66.70.72-75.doc
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No. 20596 : h
4# Fxp. 9-30-01 1
OF CAI.�E�
STANLEY C. MORSE GARY DOKICH SKIP SCHULTZ
r
FROM : SOUTHWEST ELECTRIC CO
r
360-1866
PHONE NO. : 772 6998
LO I—LA
SOUTHWEST ELECTRIC COMPANY
77-734 COUNTRY CLUB DR. SUITE K
PALM DESERT, CA. 92211
Dec. 07 1998 01:53PM P2
Llc. #750740
DATE: 12-7-98
JOB; PLAN l / CHAPARRAL CONTRACTOR:
MINISTRELLI
50-1.201NDI4,N CAMP RD. LOT # 75
GEN. LIGHTING, SQ. FT. 3739 X 3
11217
2 APPLIANCF. CIRCUITS @ 1500
3000
LAUNDRY CIRCUTT
1500
DRYER
4500
RANGE
0
COOK TOP
1500
OVENS
4000
TRASH COMPACTOR
1200
DISHWASBER
1200
DISPOSAL
800
MICROWAVE
1500
EXTRA KNOWN CIRCUITS (2) @ 1500
3000
POOL EQUIPMENT
6000
TOTAL LIGHTING LOAD — -- — - —
TOTAL = 39417
FIRST 10 KW AT 100 % 10000
RFMA.INDER. AT 40 % 11766
A/C 10 TANS X-2000 PER TONS 20000
41766 TOTAL LOAD / 240 VOLTS = 174 AMP LOAD
77-734 Country Club Dr., Ste. K - Palm Desert, CA 92211-0473 FAX 772-A00A