9606-106 (RPL)LICENSED CONTRACTOR DECLARATION
I 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
614611. r. C33
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
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 forwhich this
permit is�sr �edq My�iw rkers' com'410pensation insurance ca
r�e�Uolicy no. 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 the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
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
const`tJction, and hereby authorize representatives of this City to enter upon
.the above-mentioned property for inspection purposes., ,
Signature (Owner/Agent)
A'!'IAtl;v f'it:l lir t�1�rlThrf. �t�
BUILDINGPERMIT
PERMIT"
CONTROL#
3561
DATE .
VALUATION LOT
.'ali TRACT
/20/96 ���,Ofi3ii.4lt)
JOB SITE
APN
ADDRESS
79486 FOXRUN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
COVE,
50445 Mc:,LWA�r SH A t rug ;; .itta
C,A, QUINTA CA 9225L%
(619)544-1849
I USE OF PERMIT
P(X)L Aidl31C&.:#PA
MCIN'1'i`R , POOLS & SPAS
46301 ROUDEL LANE
LA QUIWrik CA 1)2253
{61 134?.. 521
CTL# # 1945
14,4!)0,00 E.1
USTIMA'17101) COST OF CONSTRUCTION
+L`ONIS!'lMIt'.' ION FEE iQ:_100-118.000 4153.tt{i
WE ', 0.1.t1N (C,AL Fj ; . _ P00L 101 4)Q 0,42 l W $U.f3ii
Ef,1"t:`.!"RK_''t1.1.7`i+K--K)01, tot. -M0420 -01W $45,00
!'(.L� 3M ! F':i '-- POOL,' • $ (i.t �00a3 419-000 $27,00
SU1:34'al'A , CQNSTRUCITON AND PLAN 01ECK
RECEIPT DATE BY DATE FINALED INSPECTOR
4AHM10
S-143.45
$0.00
INSPECTION RECORD
OPERATION DATE f INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
OPERATION ( DATE I INSPECTOR
MECHANICAL APPROVALS '
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
PLUMBING APPROVALS
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel _
Set Backs
Electric Bond
Footings .
Main Drain
Bond Beam
Approval to Cover
Shower Pans
Equipment Location
Sewer Lateral
Underground Electric
Sewer Connection
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.
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)
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
0
Date 6/9/98
No. 17152
APN # 769-542-011
Jurisdiction La Quinta
Owner NameMinistrelli-Painted Cove, Inc. Permit #
No. 79-180 Street Fox Run Log #
City La Quinta Zip 92253 Study Area
Tract # Lot # 6�1 Square Footage 463
Type of Development Residential Addition
Comments
463 sq. ft. addition to existing construction.
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:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of
0.00 X 463 or $ 0.00 the property listed above andithat�building
t ,
permits and/or Certificates of Occupancy for this square footage in this proposed project "may,.` now be issued .
Fees Paid By N/A " `Telephone 564-1849
Name on the check -
By Dr. Doris Wilson
Superintendent '
Fee collected /exempted by Juanita Green Exempt $0.00
Check No. N/A
Signature
NOTICE: Pursuant of Ass%mbly 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 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
OF LA
13UILDIIYG QlANT
& 8AFE7-YDCpAFjT,
ACCEPT CON')ITIONALLY - yENT
ID FqR,CojVSTRUPER SUBJEC TToIlYSTALL4TION A
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HVAC SYSTEMS
Heat. Equip
CEC
Certified Manuf.
Actual
Distrib Type
Duct
Heat
Heat
System Type
Make
& Model Number
Eff.
and Location
RVal
Load
Output
Spli".-HtPump
YOR<.
E1FH01WS06
7.200
Ducts .in Attic
4 2
11871-1
143339
Cool . Equip CEC Certif:i-ed Manuf . Actual.
<Sy.^tem Type Make '_g_h;odel N�_imber^-__ Efficiency
`_
p"ZitlitPump 1? .000 SEER
Distrib Type Duct.
and L_.oc.ation`�______ Val
Ducts in Attic 4,2