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9905-162, 9906-005 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby �ffirrn under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and U) C14 LU Professionals Code, and my License is in full force and effect. 5 M License # Lic. Class Exp. Date C) Lr) 693-899 H 09131;20( r LU r- r - Z r-- Date Signature of Contractor,4 rD 0. r- 1.– 0 'OWNER -BUILDER DECLARATION _J W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's a- License Law for the following reason: U) Z 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ce) I am exempt under Section —, B&P.C. for this reason LO C\J Date Signature of Owner 0 C\J 0 a) < WORKER'S COMPENSATION DECLARATION Z 0 cr I hereby affirm under penalty of. perjury one of the following declarations: Lo < FZ 0 1 have and will maintain a certificate of consent to self -insure for workers' X LU ILL. compensation, as provided for by Section 3700 of the Labor Code, for the 0 _J _J performance of the work for which this permit is issued. ED _J < < 0 1 have and will maintain workers' compensation insurance, as required by d (-) <� section 3700 of the Labor Code, for the performance of the work for which this LO 0) permit is issued. My workers' compensation insurance carrier & policy no. are: `* Z Carrier Policy No. A I cb =) 11 T IV J - 113, JrFU NNDI 134 649-00069,23 C3 < (This section need not be completed if the permit valuation is for $100.00 or less). _J ( ) 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 subj9ct to the workers' compensation provisions, of. Section 3700 of the Labor Codb, I shall forthwith comply with those pr–ovision'si. Date: Applicant— UWarning: 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 above-mentioned property for insp6ction purpos–es. X VSignature (Owner/Agent) Date PERMIT # BUILDING PERMIT DATE VALUATION $224,767.30 LOT 59 TRACT 25429 JOB SITE '79-120 FOXCRUN ADDRESS APN 769-542-00S I OWNER CONTRACTOR / DESIGNER / ENGINEER MWISIMELLI-PAINITED COVE. TINC. C()Vf;. 'Wc. 74-785,"tY 111 $11105 74795 HWY I I I S113 105 INDIAN WELLS C'A 921,2210 INDIAN NVEILS CA 192210 (76(�)776-44,50 Mil 35,25 USE OF PERMIT SINGLE FAMILYEWTILLNG ST,13 - PERMT DOES' NOT INCLUDEBLOCK WALLORPOOL. "IM 2212t .7 7.35 f Eg DEPCwt, 101-000-439-318 MECOMPRICAL FEE S 14 -1. 00 RLWMICAL F'Et 10t-000-420-000 'MANBING FEE 101-000-419-000 STROING WY110N F-fiE. -RESID 1101 -W -241 -ON) M OXADT140 Y,E_ S20.00 INFIWTIUXTURE ITIM 225-00&-443-342 1$11,9 11. 916 AftT IN PUBLIC Yt.A0'.-.'8 -RES'IC 701 -OW-255-000 S,11*4.42 P1. AN C'flF(X IT -9 W140-439-319 SUR:rOTA4, CONSMUMPN ANDPON (34F.CK LESS 11.111LE-PAWFEE's "'Alm LJ 42-50,00 , COTAL PERMR'FEES DUENOVY JUN 0 8 1999 ST,6681S "ITY OF QUI"'-- ry 1, RECEIPT DATE lay ATE FINALED SPECTOR V A? AL� INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE TINSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS . Underground Ducts -S-et.Backs Forms & Footings C2 Ducts .Slab Grade 6, :2: 23 !j '�7 Return Air Steel Combustion Air Roof Deck 7- -Z-9 9 Exhaust Fans 0. K. to Wrap F.A.U. Framing 7-2 Y— 9, Compressor Insulation 7--2-9— AC Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Extedor-Lath Drywall � Int. Lath Final Final tzi- BLOCKWALL APPROVALS 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 7 -62.1 7 _7.7� S11 Heater Final Water Piping Plumbing Final Plumbing Top Ot4 Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection j 1. 0", Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas). ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring - w Low Vohge Wiring Fixtures Win.Service. Sub Panels Exterior Receptacles_ G.F.I. Smoke Detectors Temp. Use of Power Final 2 Utility. Notice (Perm) COMMENTS: 4ht 4 4"�Apu &P P.O. BOX 1504 ���V�/�%�%�?��"" �r� Building �j %% 78-495 CALLE TAMPICO APPLICATION O LY Address / -1 u LA QUINTA, CALIFORNIA 92253 Owner ru) /? P({(.77 vA) BUILDING: TYPE'CONNST. OCC. GRP. J /a S� A.P. Number Z, �:5 .� �'-',o � Legal Description ' 2Z1Z15_d T S Project Description SrA /N/ Mailing Address ver/, X12?/D Contractor _ A) Address Zip j Tel. State Lic. City & Classif. G�'(j Lic. N Arch., Engr., Designer 1 j %JAJA ,, n v1 --rbAf v,,P , Address I Tel. CityI Zip I State Lic. If LICENSED CONTRACTOR'S DECLARATION ' 1 hereby affirm that I 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 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 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 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 not build or improve for the purpose of sale.) 1'1 1, as owner of the property, am exclusively contracting with licensed contractors to con- struCl 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 contractor(s) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that Ihave 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 171 Copy is filed with the city. O Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars (E 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: 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 shell be deemed revoked. a' 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. 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 Sq. Ft. 3 -u 3 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ MAY 101999 ` 1 C) Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. gra( Plan Chk. Bal. t 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 Issued by: Date Permit Validated by: Validation: 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 6/4/99 No. 18839 Jurisdiction Owner NameMinistrelli-Painted Cove, Inc. APN # 769-542-005 La Quinta Permit # No. 79-120 Street Fox Run City La Quinta zip 92253 Tract # 25429 Lot # 59 Square Footage Type of Development SFR Mitigation Comments Jran at ere - 1,723 sq. ft. Log # Study Area 1 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 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 iig` . now be issued T Fees Paid By cc/1st Community Bank/Ministrelli - Kevin Peters -telephone; Name on the check By Dr. Doris Wilson r - Superintendent '1v ` Fee collected /exempted by Juanita Green Payment Received $628.00 kO Check No. 085891 Signature NOTICE: Pursuant of sembly 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 rurf4rom 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 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 Dear Builder: Tiiy/ 4 s(PQ" PUBLIC WORKS CLEARANCE LETTER FOR CUSTOM HOME LOTS Prior to issuance of a building permit, you will be required to obtain clearance from the Public Works Department for one, or more, of the following: 1. Verification that rough grading is complete, and the pad elevation certifications prepared by a licensed surveyor, or engineer, are on file in the Public Works Department. 2. Verification that infrastructure improvements and other required tract improvements are complete, or sufficiently advanced to warrant building permit issuance. 3. Prepare an engineered grading plan that provides for on -lot storm water retention, and have it checked and approved by the Public Works Department. • Tract 26524 (Estancias) • Tract 26769 (Mountain View Estates) 4. Prepare an engineered grading plan that provides for building pad grading in accordance with the existing soils report and tract grading plan, and have it checked and approved by the Public Works Department. • Tract 28034 (South Valley Estates) FOR INTERNAL USE BY PUBLIC WORKS DEPARTMENT TRACT. �?5q2 / LOT: 7,/" PUBLIC WO S AUT RIZATION DATE F:VPWDEPTIDOCS\FORMSIPW CLEARANCE LEfTER.ss COMMENTS: