9603-027 (SFD)AV
LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I 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
RUf
Date 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
-x„
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 isTissuedJJ VE orkeFsi`compensation insurance ca"rrrien.& p"olicyano. are:
Carrier Policy No. ,
(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 thefLabo}r
Code, I shall forthwi comply with those revisions
Date:eZ". 4 9 Applicant
Warning: Failure to secure Work rs' 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, indemnity
& 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 p rpesseeg�., ` ..
Signature (Owner/Age/Gs.(spata!M
PERMIT # CONTROL #
BUILDING PERMIT' 9603-027
2980
DATE 311jt�� VALUATION sa,��.,i LOT .' TRACTtw1y
OB SITE
ADDRESS % f1 1) �� Off. RUN .
APN .769-540-01 it
OWNER
.w
CONTRACTOR / DESIGNER / ENGINEER
i'.IIN1IS1,1ZET,L!-PAIITrET1C0V E,
COVE,
50445 :MOUN',1'AIN Sk3AWWS ib) -
50445 &TOUNTA.IN Sid. WOWS RD
LA, f, UNTA CA 922.53
LA QU1NTA CA 92253
�F!!? 5ti4-11149
(619)5564-.1849 CBL9 3625
USE OF PERMIT
S.iNGLH FAM1i 1 EW t. j:,T I.N0i
4
k_VLY;�P! KUL ! t\JL'`E 9,3! J. �1•
F'OR(.'E-L"PATIC) 4l A9) SF'
v: ARAIC.131CAPWOR [ t g'I..tN) .S1
's,r)1L1A•, C.0 COST OF C:OINSTRUMKIN
199,:9!93+.111
1)'.3t;.ij�:i141'R' Ii'.1�!° 4i111~11fi�1,iZ,Y
P1'.ceN r11RCK-'n fs $814.186
C`01.IS RUC.1'ION Fist: 101-WO.4.18.000 39$9.5()
IEZ1:1ANICAL FEE 101.-000.121-000 o1G)3.CiQ
.1!(:9`ItILA%. 1�E 1f}l-ti{1fia�2 {MdOq $I04.45
+1',ttiltl;'IN�.I VD -11 1.0140 0419-000 $11.'7.Oti
co ,
STON't,� n30° ION FICIP- fmal1a ' l(K-0 0-241.0%, W1 0 $.(
' C'__J C"
GRAf0NW; 1'Ili,' 101-000-1-123-000
I_td't '1f A:1 i'f2'f lC; ii'> rR,F< :C E�ii 215-000-443-342 iS4.428.14
O
AXI' IN I?Y,T13l,lC PI;.ACHS , WE. i 101.-00.155-Q(1()
FRE M1.1V(31r t-S�Sf?.Ofi
I n-
SUB-1101'A.L CONST1ZL.tc."C1t3WAND PLAN CHECK.
951..:/5
LESS .P1.'tE�-.PAi#: FIE S
-$250.00
TOTAI, RCib:1 Irf :FfFU% DVF_N0•)'W'
$6,701,95
RECEIPT
DATE .
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
47
Exhaust Fans
O.K to Wrap
— g'
F.A.U.
Framing476
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines `
Party Wall Firewall
Exterior Lath
_ 44
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 APPROVALS
Gas Test
Electric Final
Waste Lines
zHeater
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
Z0
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
Final
Utility Notice (Perm)
Building
Address
owner
Mailing
Address
City Zip
9
Contractor A.
ress
City IZip
P.O. BOX 1504
78-105 CALLE ESTADO
f.I 4/ti LA QUINTA, CALIFORNIA 92253
APPLICATION ONLY
Ir -•L/
BUILDING: TYPE CONST OCC. GRP.
A.P. Number 19 i LY"' /
---G�j -
Tel .r61
'Legal Description I� a
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
/' Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70001
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.)
I 1 I, as owner 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 thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
11 1 am exempt under Sec. B. & P.C. for this reason
Date 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
r] 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 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 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 it 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
BUILDING DIVISION
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New -B[ —fA Iter ❑ Repair ❑ Demolition ❑
v
EB 2 7 1996
- _ r
v
Estimated Valuation
PERMIT c AMOUNT
�2 J- l✓U
Plan Chk. Dep.
Plan Chk. Bal.
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
2ND FL, SQ. FT, @
HEATING (ROUGH)
YARD SPKLR SYSTEM
FORMS
POA. SO. FT. @
MOBILEHOME SVC.
BAR SINK
ROCK STORAGE
GAR. 'SO. FT. @
I I POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP./EQUIP.
REINF, STEEL
DRAINAGE PIPING
TEMP. POLE
CAR P. SO. FT. @
GROUT
WATER HEATER
WALL S0. FT. @
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
SO. FT. @
URINAL
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
FRAMING
NOTE: Not to ne used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
—
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
LATHING
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
INSULATIONISOUND
BOILER B.T.U.
$0. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
FINAL INSPECTION
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ I 1 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
INSPECTOR'S SIGNATURESJINITIALS
GAS PIPING
GARDEN WALL FINAL
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND, REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF, STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
—
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
Notice:
Document Cannot Be Duplicated
Date 3/19/96
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
APN # 769-540-011
No. 14271 Jurisdiction La Quinta
Owner Name Ministrelli
No. 79180 Street Fox Run
Permit #
Log #
City La Quinta Zip 92253 Study Area 125
Tract # 25429
Type of Development
Comments
Lot # 56
Single Family Residence
Gmadtathered 3375 sq.
Square Footage I
No. of Units I
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 Ministrelli - Painted Cove, Inc.
Name on the check
By Dolores A. Ballesteros
Superintendent
Fee collected /exempted by Pauline Pearson
Signature 2�
Telephone: 564=1849;
Payment Received
Check No. 2452
$628.00
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
MINISTRELLI
CONSTRUCTION
COMPANY, INC.
50-445 Mountain Shadows • La Quinta, CA 92253 • (619) 564-1849 • Fax (619) 564-5530
March 15, 1996
vity of I - Quinta
78-495 Calle Tampico
La Quinta, Ca. 92253
Re: Architectural Committee Approval - Lot 56 Tract 25429
79-180 Fox Run
- Dear Sirs,
This letter will confirm the Architectural Committee approval of drawings to be
constructed on Lot 56 tract 25429, as prepared by BBG Architects.
Should you require any additional information, please contact our office.
Sincerely,
Ken Schmale, President
Architectural Control Committee, Painted Cove
KS: rm -
A,OiWwiman —Jtiy
(�trt
of
B."R
-00
0.L r ff
mg.
Tit� of 14a(011tonta
hithiion
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For .the following:
BUILDING ADDRESS 79-180 FOX RUN
Use Classification SINGLE M T T.Y DW .T.. T N, Bldg. Permit No. 9611-027
Group R3 Type ConstructionVN Fire Zone Use Zone R3
Owner of Building MINISTRELLI Address SAME AS ABOVE
City LA QUINTA eycKIRK KIRKLAND
note: 10-22=96
Building Official
POST IN A OONSIICUOUS ►LAC[
III