9809-038 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (^ommencing with Section 7000) of Division 3 of the Business and
Pr,;fes ior,, A Code, and my License is in full force and effect.
Lic�nse # Lic. Class Exp. Date
vza tlC j 813 U60
60
Date ' t ' 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). V
( ) 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.)} 1 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.
.it1EE1"7JN111 L��G v- (306 23
(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.
Date:,' "- Applicant
Warning: Failure to secure Worker's 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 above-mentioned property for,rin'spection purposes.
/Signature (Owner/Agent) <w Date° I
9?3ti�i�tl�?t
BUILDING PERMIT PERMiTIi °°NTR°`"
DATE c/ VALUATION $195,714.90 LOT 49 TRACT 1 8,276 276
JOB SITE 74` -AS 1*0X aYhJ(til
APN 769-5,50-04-S
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
c(� T. itir-.
Rri*.ISI ��.r,:'.t,I.•P ;Frrz�.�D
74783 14VVY i L,1 �! it 105
74785 {-MY [).! STT 105
INDIAN WELUN CA. 92210
1NDEAN WELLS CA: 92710
(7Ct)171t1-�! X50 Mfb M25
USE OF RMIT
nlIPyL`Ee�
+3E.".Ao LY D VELLNG
,
SFD _ ►tRWI t rX)Fv :IvQ?T INCLUDE i3L: CkTK WALL.'s OR K- 10 ,.
I `T CONMIRUC1110t� 3F
RAC 3.2,41
7102'),011PATIO 392.00 ;F
`
PIONI.S.T. l�Y i0N,
TSTIAyypp3D COST of,
.195, 74'. 10
CONj1:ttfJaPIONFEE 101-000.41843(3Ci 5975.St�
PY,AN CisrFCK fKT
yy��yat, s
Fm
.t'F�'„C !JFk`�e?a
MECHANICAL FEE $98.50
FLEC7I41CAL F118 2Ut-000420-l}Ot) $219.69
pi'l fMP;1p,s(-f ra-F� 101-C 00.4140110 $1 IQ Ii
STIZON(33 a=`0T(01atTX-,-.RUSI3 101-000.2144-000 19.gs
0R.AD WO FLIL? 10 -000-1123-040 $2+).00
fN KA STRUC' 1`l;Tt2:E ,F03 2.2540-44-1342 `4.287.03
ART (N PIJBIAC MACES - KES113 l0 ,.-000-25?-0013 $2.19.44
f
E
a Q
YJ'J.3=IX) A1, C;'CIINSTIR1,146N AND PLAN C'HliCK
P �. LESS PRE -PAID iTES
_$29.00
JUN 0819991'Al. PERMIT FEES DrJE,NOW
OF LA .QUIN d'I
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
S6, Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel .
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
`I .
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
2 —�
Final—
BLOCKWALL APPROVALS
Final
POOLS - SPAS
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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 a
Wtilily Notice (Perm)
COMMENTS:
f
Building 74
Address
Owner �/f
/w/
Mailing
Address79
City
.:r,V bIAN l�/L
Contractor
Address 1
t
P.O. BOX 1504
78-495 CALLE TAMPICO
1A/ LA QUINTA, CALIFORNIA 92253
? y /// Sv/
r Zip
(as
927 /a
City IZip ITel.
State Lic.p City
& Classif. 93 8 (q Lic. k 3 J
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State I
Lic. q
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing 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 he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 or 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 five hundred dollars ($500).
(': I, as owner of the property, or my employees with wages as their sole compensation, will
d0 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. I1, 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.)
I 1 I, asowner 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 (hereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I1 I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I have a certificate of consent to sell -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n 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 permil is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thip 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 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 validated, and is subject to
expiration if 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 state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of aOplicant —Date—
Mailing
ateMailing Address
City, State, Zip
P LI ATI
A P C ON ONLY
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number -16 155"00 LISW
Legal Description
Project Description s r N
336,2
Sq. Ft. No.
Size Stories
New ❑ Add ❑ Alter ❑
OS uN
i
Estimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS h
No. Dw.
Units
Repair ❑ Demolition ❑
AMOUNT
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�Line
FINAL DATE
Issued by: Date� - nupsmit
Validated by:
Validation:.
J
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Desert Sands Unified School District
�l 47-950 Dune Palms Road
�~ Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 10/7/98
APN # 769-550-045
No. 17855 Jurisdiction La Quinta
Owner NameMinistrelli-Painted Cove, Inc.
No. 79-105 Street Fox Run
Permit #
Log #
City La Quinta Zip 92253 Study Area
Tract #. 25429 Lot # 49 L,& Square Footage 1
Type of Development Single Family Residence No. of Units 1
Comments
Under grandfather agreement 3,247 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.that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By CC/1st Community Bank/Kevin Peters Telephone ,
Name on the check
By Dr. Doris Wilson
-Superintendent
Fee collected /exempted by Juanita Green Payment Received $628..00
,,,, / Check No. 081756 .
Signature
(Iulmi'4' i�X�i�-�
NOTICE: Pursuant of Asset1bly 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 frorr he 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
i
. z
V S
c'rM !CID
of n+��
1
Dear Builder:
M
i
i
Prior to issuance of a building permit, you will be required to obtain Public Works
Department approval for one of the following:
1. Verification of pad elevation by a licensed surveyor or engineer.
i
l
2. Engineered grading plan for project requiring on -lot retention.
Tract #26524 (Estancias)
Tract #26769 (Mountain View Estates)
i
i
3: Verification that the building pad has been graded and compacted in accordance
with the soils reports, and tract grading plan.
Tract #28034 (South Valley Estates)
Public Wor s Autho ization
f �
q79�4V 12`
�i
c:PWauth.Itr/da "
OCT -05-98 MON 0242 PM MDS CONSULTING FAX NO. 714 251;0516 P.01
f
MDS CONSULTING—...-
PLANNERS
ONSULT/NGPLANNERS - ENGINEERS - SURVEYORS
17320 Redhfll Avenue, Suite 350
Wine, CA 92614 (949) 251.8521
FAX 251-0516
October 5, 1998
Engineering Department
City of La Quinta
78-495 Calle Tampico
La Quinta, CA 92253
Post -it- Fax Note
7671
pz►
To 0 1
From
47.4
combpt
Co.
71
Phone #
Phone #
None
7_ _
Fax 07(o6 -5-&f
Fax #
Rough Grading Verification
La Quinta -Tract 25429
We have checked the area referenced below and find It to be in substantial conformance the approved
precise grading plan.
Lot #
Elev.
AS -Built Elev.
Variation
-1.., 49
47.4
— 47:5 —
0.1'
71
50.0
50.0
None
Stanley C. Mo1w
R.C_E.20596
Expires 9/30/01
G:\307\A4ker-M9and71.d0c
/ROFES.
V
No. 20596 rn
Exp, 9-30-01
��9Tc' OF
CAL
MDS
STANLEY C. MORSE GARY DOKICH SKIP SCHULTZ
S
I ESI/FME,
STRUCTURAL ENGINEERS
November 23rd, 1998
MINISTRELLI CONSTRUCTION CO.
50-445 Mountain Shadow
La Quinta, CA 92253
ATTN: Kevan Peters
n l
CONSUL TANTS
RE: Roof Truss Calculations and Layouts on "PAINTED COVE" , Plan 313" -Lot 49 to
be built in La Quinta for MINISTRELLI CONSTRUCTION CO. (ESI/FME 194-6225 /
BBG 124-0612)
Dear Mr. Peters:
We have reviewed the calculations and layouts by SPATES FABRICATORS and they appear
to comply with the requirements of our calculations and plans.
The review of these drawings does not relieve the contractor from compliance with the
drawings and specifications. This check is only for review of general conformance with the
design concept of the project and general compliance with the information given in the contract
documents. The contractor is responsible for confirming and correlating all quantities and
dimensions, selecting fabrication process and techniques of construction, coordinating his.
work with that of other trades, and performing his work in a safe and satisfactory manner.
In addition at your request, Our Office will provide field observation for the above mentioned
project.
Thank you for your attention to this matter. Please do not hesitate to contact us if we can be
of further assistance to you on this project.
Sincerely, .
ESI/FME, Inc.
1921 E. CARNEGIE AVE., UNIT 3-J, SANTA ANA, CA 92705 ° Ph. ( 714) 261 - 1811 / FAX ( 714) 261-8506