15220 (SFD)Building
Address 7,-,.,,, Dry Creek
Owner ministrelli Construction
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Mailing
Address 50-445 Mtn. Shadow
City Zip Tel.
La Quinta, CA 92.253 564-1849 -
Contractor
Same
City . ' Zip I Tel.:'
stateiB 693899 (City 3625
& Classit. , _ Lic. #
Arcn., tngr.,
Designer BBG: Architects
breLsoxparate Park 1(1!2'14) 261--1795
CityZip State
irvineri C.A 927.39 Lic. #
i
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under-provislons of Chapter 9 (commencing. with Section
7000) t. of DivisioP.3 of the Bysiness�afid• rofessions Code and my license is in full force and
effec�� ,y
31GNATl1RE .++' DATE
"(
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors 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 Ole 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 rive hundred dollars ($500).
❑ 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 nofbuikf or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to corn
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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hepby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker' Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poli No. Company
Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
=action need not be completed it 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. N, 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.
No. 15220 .
BUILDING: TYPE CONST. . OCC. GRP. R3
A.P. Number 769-541-018
Legal Description Lot 17 Tract 26016
Project Description SFD
Sq. Ft.No. No. Dw.
Size .232.9. Stories Units
_`
New ❑ Add ❑ Alter ❑ ' Repair ❑ Demolition ❑
Permit does not include block walls
10r. po-01 e .
Estimated Valuation $141,074.00
PERMIT
Plan Chk. Dep. -z
Plan Chk. Bal.
Const.
Mech. -
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
krts in Publi(
TOTAL
REMARKS
AMOUNT
MO. 00 -
416.01
786.50
•83.00
157.s u2
174.00
14.11
20.00
.00
3,123.29
:s 102.69
127.22 4.877.22
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,AND-
_ Side Street Setback -from Center Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, .
—Side -Setback m P Operty Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
I
v I
Ttiis is a buildingFINAL
permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I
U
DATE INS EG TOR
1 i
U C I
GDate'95 V Permit
certify that I have read this application and state that the above information is correct.
Issued by: tt It
I agree to comply with all city and county ordinances and state laws relating to building
v �. •- ,.
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes.
Validated by: f
Signature of applicant Date
r p p 1 1
Mailing Address
'Validation!
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES
1ST'FL. . SO. FT. ® $
UNITS
COLL. AREA
SLAB.GRADE
2
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT. p
HEATING (ROUGH)
STORAGE TANK
n..
FORMS / L — S�
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT. ®
GAS (FINAL)
I
WALL SO. FT.
DRINKING FOUNTAIN
GROUT
WATER HEATER
URINAL
SO. FT. ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
rj
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 6 AIR COND. SOLAR
SETBACK 2
UND PLUMBING7,J
v
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB.GRADE
2
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
n..
FORMS / L — S�
ER OR SE///PTIC7I�.gs
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REIN . ..- t %
•/V
(ROUGH). �}
l
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
EINF. STEEL
f
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$ '
LUMBER GR.
AL INSP. Z-1 `q S
FRAMING v;/� S'
FINAL INS / - ,;�,
OOFING ` o lo--
7
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
111011
THING `(Y
MESH
INSULATION/SOUND
FINISH GRADING
NAL INSPECTIOP(,4-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESlINITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500
Date 6/21/95 1 Type of Permit La Quinta
No. 113517 Permit #
Owner Name Ministrelli Construction Log
No. 78965 Street Dry Creek
city La Quinta Zip 92253 Study Area 125
APN # Tract # 126016 Lot # 17 Square Footage 1
Type of Development I Single Family Residence No. of units 0
Comments Grandfathered
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
This certifies that school facility fees imposed pursuant to Mitigation Agreement
in the amount of 628.00 x or $ 628.00 have been paid to D.S.U.S.D. for
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 .
Name on the check
is r���
B Dolores A. Ballesteros
Y IT
Superintendent
Fee collected /exempted by Pauline Pearson
Payment R,ecei-'Ved 4_.
Signature -0 P f rA'ch6o.- No. 1669
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