13710 (SFD)U ceit,, 4 4 Qu`�# *A�
P.O. BOX 1504
Building 79-140 Coyote Creek
Address LAQUINTA CALFORNIA92253
Owner
Ministrelli Construcion Co., Inc
Mailing
BUILDING: TYPE CONST. VN
Address 50-445 Mountain Shadows A.F. Number 769-550-038
City Zip Tel.
La guinta, CA 92253 (619)564-1849
Contractor
Address
P.O. Box 3371
City JZip Tel.
Palm Desert C� 92261 (619)564-3673
State Lic. City
& Classif. B 451035 Lic. # 1463
Arch., Engr.,
Designer BBG Architects, Inc.
Address Tel.
26 Corporate Park
City Zip State
Irvine, CA 1 (2714 Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapler 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
1 hereby affirm ihTl I am exempt tram the Contractors License Law for the following
reason: i5a+c. 7031.5.8usboss and Prolossions Code: Any cey or county which requires a
permit to construct, alter. Improve, demolish, or repair any structure, prior to its Issuance also
regrWres the app/fcanf for such permit to Me a signed statement that he is licensed pursuant to
tfle provisions of the Contractor's license law, Chapter 9 (commencing with Section 7000) of
DMaion 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 Man five hundred dollars (5500).
❑ 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. 7011, Buisness and
Profassx)ns Code: The Contractor's License Law does not apply to an owner of property who
buYds 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 ff, however, the building
or improvement is said 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, as owner of the property, am exclusively contracting with licensed contractors to com.
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 confrac(or(s) licensed pursuant to the Contractor's License Law)
❑ 1 am exempt under Sec. N. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. —Company
❑ Copy is filed with the city. Q Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(this section need not be completed if the permff is for one hundred dollars (5100) valuation
or less.)
I certify thal in the periormance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject 10 the Workers' Compensation
Laws of California
Dale—Owner
NOTICE TO APPLICANT: M, after mekirrg mus CeriRicare of Exemption you should become
subject to the Workers' Compensadon prRvfsions of rhe Labor Code. you must forthwith
comply with such provisions or this permit shalt 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
i..ender's Address
This is abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
certify that I have read this application and stale that the above information Is correct.
agree to comply with adi city and county Ordinances and state laws relating to building
i construction, and hereby authorize representatives -Of this city to enter the abova
mentioned property Ior inspection purposes -
Signature of applicant Date
Mailing Address
i City, State, Zip
No. 13710
_OCC. GRP. R3
DescriDtion Lot 43 Tract 25429
Project Description SFD
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:
Sq. Ft. 3375
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit does
not include block wall or
pool.
Estimated Valuation
$200,690.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
95
Plumbing
3 87 5Q
S.M.I.
Grading
Driveway Enc.
Infrastructure
4,429- 14
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: