9604-124 (SFD)U)
N U)
W
O0M,
r� 0 L0
W
Cr r
O
H o�
W W C°
I— D_
Z
M
LO
N
ON
U °)
Q
T Cr
Q O
W
X W —
mUU
O
Il rn H
coo
�O
a
J
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
AAN999 C -.3/31/%,
Date Signature of Contractor
I 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 for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Afi-lj,1Wf'&i:I 4J)U8'6' Policy No. .old; is7-
(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
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT# CONTROL//
y��-� 24 3260
DATE 5/ 796 VALUATION �Z�D Z.� LOT �S TRA;GTj.129
JOB SITE
ADDRESS '79.20U !'d x RUN
APN 769,.542,412
OWNER
CONTRACTOR / DESIGNER / ENGINEER
50443 NIOUNIAIN SHADOWSRE)
30,143 MOUNTA,;N .SaA SOWS RD
LA ('?ULWfA. CA, 9225:4
LA QUINCA. CA 92253
(619)561,1&49 Q i,'L'If 36.15
.
USE OF PERMIT
�1:(ViiLlz 1,'}LAilisl° I)'41ff;l...l�iiVi`i
PFRX11'f DOPS N011' tNCLUI)E BLOCK U IVLI, OR F'1 -S3 PtEF'1,'ECt A' t i..t56 C'ti-w1.'1' FoR
�lt'I'f; !� l�if�LFC:.IA1,A;:"F3 f'tft AC'i.17.Fsr;l�(H"j�r r�l�C"1'fF t,;'�, COR�II�9_iJt�'1`1'1'9JisVFt.�Jlsl�i"alsi' Faf:3''i,
Ci3;,T31'.KIIC't'ION 3.*400) 3F
0ARA0I•JC AR(•0 PT Sr.
1v.STI[eiAT.E%COST OF f` a* WNS"w''RUCTION
2U.661.40
c {Ji�ui'Ft:tTG4'LC`NFM' idJ O -Ali -f3U0 f,0ai,€;U
OLt>NCIff:C.K7=EC 101-{) O -4.39 -:fix?' $9.21.W
fk,4_-' NA.NI A:Lr F1;J- 10J.-000421-000 ili.tnf
°LfLL141G;NO r1_-Tj 10140-419-000 5243-25.
rift 6�IV« t1,1.t"r f'i:0N 11;.E -12 411:1 1()1-000-2=1.6 -11110 $21'4'7
t':{(tA0I'N(_1 FL -1; 10,143131,-423.000 $26.ir#
fRr 'tt.r?S`1'ftl l+.af t IRE1'61't5d 00 -X64'`; -;fid? .85,(1.1."_
_+,,•, "', tj l�'�[�.7 I�x`Uw {.-VlW iS '4tJN !' D PLAN tfs, 1.Ei..+.LR.
1099.59
LESS PRE -PAID REES
42`0,4 o
TOTAL PERMIT1 E'ES 1!'.)llii'NOW
j
S7,449-59
RECEIPT
DATE r;
BY f
DATE FINALED
INSPECTOR
T_11 '_-t'- -- -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
(
Ducts
Slab Grade
gr
Return Air
Steel
Combustion Air
Roof Deck
(p
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
-
L
Compressor
Insulation
II!:—:�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
FinalI Zo G
Final 2
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
(� ^ 6_
1465
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
/S
Encapsulation
Gas Piping'
Gas Test
-
Appliances.
Final
Final 16 -22
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 (, • ,Z [
Utility Notice (Perm)
LGC
COMMENTS:
-
Z,
P.O. BOX 1504 APPLICATION ONLY
`Bui din /7 / 7&105 CALLE ESTADO
Address -ZOO ,-jx zee,/LA QUINTA, CALIFORNIA 92253
Mailing J� /� BUILDING: TYPE CONST. �t"' ,/� OCC. GRP.
Address 5O "Y � A / %^�� __=� 'Y�//Z
/1/. ,�l . C'!'LC� A.P. Number 6 .�
Cit Zip Tel. / �_� %�� ar�C`4429
{�� f �� ���j�— 70 Legal Description ,G1� .-, � / Ik'/�GV� �) i
Contractor � ,[ � � Project Description
Address
City lZip Tel.
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr.Size Stories Units
,
Designer c"C.At��A New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
74/111 <-<- Aeo�. 7 7/_ - SP417
Ciyty� �j' Zi State
T;4 /l1 �S�/41 �k �L� Lic. If
LICENSED CONTRACTOR'S DECLARATION
I 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, after, 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).
[; 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 suchimprovements 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 11, 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.)
I 1 I 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
F1 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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.
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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING DIVISION
.2
uat
PERMIT AMOUNT
Plan Chk. Dep. p.
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 Setbackf=rom Prope� y -Lime
FINAL DATE
INSPECTOR
1lam!
Issued by:�Daate
1 1 in. _ Perniit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IR
1ST FL.SO. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
FORMS
2ND FL. SO. FT.
ROUGH WIRING
DUCT WORK
ROCK STORAGE
POR. SO. FT.
MOBILEHOME SVC.
BAR SINK
HEATING (FINAL)
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
TEMP. POLE
DRAINAGE PIPING
WATER HEATER
CAR P. SO. FT. 0
FINAL INSP.
BOND BEAM
WALL SO. FT. @
DRINKING FOUNTAIN
=$
SO. FT. ¢
-
URINAL
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
--
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
LATHING
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
INSULATION/SOUND
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
FINAL INSPECTION
SO. FT. cns c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID Cid 1I c
SEWAGE DISPOSAL
INSPECTOR'S SIGNATURES/INITIALS
SO.FT.GAR @ 14c
HOUSE SEWER
GARDEN WALL FINAL
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 & 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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Notice:
Document Cannot Be Duplicated
Date 5/1/96
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619 775-3500
CERTIFICATE OF COMPLIANCE
No. 14410 Jurisdiction
Owner Name Ministrelli Construction
No. 79200 Street Fox Run
City La Quinta Zip 92253
Tract #
Type of Development
Comments
Lot #
Single Family Residence
Uirandfathered 3840 sq. ft.
APN # 769-542-012
La Quinta
Permit #
Log #
Study Area 125•
Square Footage I
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 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 a LA J , AA n � 0 N1 AA IC26nLL
Telephone' X564-1849
Payment Received $628.00
Check No. 2507
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
, o'
16
PAINTE D'COV.E '
` LA QUINTA
• , � April 26, 1996 .- .. • • ' - .; : , • _ " `-•• ,.
City. of•La Quinta
78-495 Calle Tampico
La Quinta, Ca: 92253
Re: Architectural Committee Approval Lot 55 Tract 25429• `
79=200 Fox Run -
Dear Sirs,
This letter will confirm -the Architectural Committee approval of.drawings to.be
.constructed on- Lot. 55 tract 25429, as prepared by Stanford & Leon hard.'Architects: -
Should you,'e quire any additional information,. please contact.our office.
Sincerely,
Ken •Sch.male,.-President
Architectural Control Committee, Painted Cove " <
KS.: rm
A.;im 0W -01-b l ' 50-445 MCiUNTAIN SHADOWS
LA'QUINTA, CALIFORNIA 92253 `
TELEPHONE: 619.564.1849
FACSIMILE: 619.564:5530 '
i
BUILDING &SAFETY DEPARTMENT
777-7012 '
INSPECTION REQUEST LINE
777-7153
Owner AWaSTRELLI-PAINTED COVE
Contractor STRELLI-FAINTED COVE
Permit' Number
9604-124
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-200 FOX RUN
SFD-PERMIT DOES NOT INCLUDE BLOCK WALJ
OR POOL
TYPE OF INSPECTION
FOUNDATION & SETBACK
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
INSULATION
PRE -ROOF
COVER NO WORK UNTIL
DRYWALL INTERIOR
EXTERIOR LATH .
i POOL PRE PLASTER
J POOL FENCE & GATE
EWER EPTIC TANK
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
S BEEN SIG
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
196 TURN ON UTILITIES OR OCCUPY BUILDING
Cerfilicale ol Occupancy
City of ta Quinla
Building and Safely Deparlment
This Certificate issued pusuant to the requirements of Section 109 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:
Use Classification: SINGLE FAMILY DWELLING
Group: R31 Type Construction: VN
Owner of Building: MINISTRELLI CONSTRUCTION
Building Official
79-200 FOX RUN
Address:
City:
By:
Date':
POST IN A CONSPICUOUS PLACE
Bldg. Permit No.: 9604-124
Use Zone: RL
50-445 MOUNTAIN SHADOW
LA QUINTA, CA 92253
KIRK KIRKLAND
10-22-96