9607-093 (RPL)LICENSED CONTRACTOR DECLARATION -
I hereby affirm under penalty. Of(perjurykat lam licensed under provisions of
Chapter 9 (commencing with Section}7000) of Division 3 of the Business and
Profeasionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
` 2U'!, 41 C-53 3/31/A)1Date-1/, Signature of Contractor, 4
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 Labo Code, for the performance of the, work for which this
permit isti9s0ed.-'IV f-Ar'iks' compensation insurance ca?ir)er&'1p''8hb4y n5. are:
Cartier 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 Californi nd agree that if I should become
subject to the workers' compensation pr vis)J'ons of Section 3700 of the Labor
\Code, I s all fo hwith comply Wit h.those pro4isAi ns.
bate: �J Applicant' + . a.
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.] 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' pection Qurposes.
Signature (Owner/Agent)` Date411,'`-
BUILDING PERMIT
PERMITy6417-093
CONTROLk
7 GS
DATE 7/21/96 VALUATION i11,4W,00 LOT
TRACT
JOB SITE 5 4-659 AVENIDA A�1()PiT ZUKIL
ADDRESS
APN 774-264-1103
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MAhl:.WARITI'
NIAS'nilt POOLS
54659 AVENiDA hf0N 1*E7AJ&4A
73555 EiWY I i i
LA QUINTA CA 01251
PALM I F8F RT
CA 02160
Ili)9)W.)-6115
CISL# 16
USE OF PERMIT
ANI JOI MIA
KX.)L ANI! 811A ONLY
R►'tTUATED C*0SM OF CONSTRt1UKIN
11,600ma
fi11i1 AHA'
H`1T I01-(XX)-4:t9.3IK
59).90
:' il�I'utA_'1'lt1N ! lili !0i-cw-1!R-0(?C1
hil-C1IANWAl,1-15i . i )OL 101 -000 -421 -ow
)il.P.Cl'RICAI. I.7:)? - NX 11, 101 VK) -42040)
S45.00
)'1.tlf�iltltJt7 F1 i - pJ?CrL I01 -0(X) -4I9 -(til)
$27 'X)
r I
,f11Y)TAL CONSMUC-110N AND PLAN C!iRCK
$30390
LESS
PRE -RAID lTA7.S
$0.00
L I UT FEE.8 DUE, NOW
)D
"03.90
-,�j 96.
tw g
Y
I
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
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
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 6 7V
Final
Gas Piping
PLUMBING APPROVALS
Gas Test 8'
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 CAW
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)
MASTER PHLS & SPAS
JUL 2 5 1996
Td4t 4 4(v Oubt 0
RECERV ED
78-495. CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 - (619) 777-7600•
FAX (619) 777-7101
July 23, 1996
Master Pools
73-547 Highway 111
Palm Desert, CA 92260
ATTN: Bill Haneseck
SUBJECT: Setback Adjustment 96425
LOCATION: 54-659 Avenida Montezuma
This letter is to report approval of the subject setback adjustment application pursuant to
Chapter 9.188 of the City -of La --Quinta Planning and Zoning regulations, subjecf to
Conditions and according to: the attached Exhibit A as approved.
SETBACK ADJUSTMENT REQUEST: To reduce the rear yard pool setback from 5 feet
to 3 feet for a private swimming pool/spa. This request also incorporates a reduction in the
southerly side yard setback from 5 feet to 2 feet for the necessary pool equipment.
CONDITIONS:
1. Obtain all necessary building permit(s) from the Building and Safety
Department, and,
2. The pool equipment location as shown on Exhibit A shall maintain a minimum
of three (3) feet from the property line of the subject property. If the 3 foot
requirement cannot be met, then the equipment shall be relocated.
After review it was determined that:
_1. .. This adjustment is.. consistent with the intent and purpose of the Zoning
Ordinance to allow development of single family house§ -aiid swimming
pools/spas in the SR Zoning District. -
sba96-425
MAILING ADDRESS - P.O. BOX 1504 -. LA QUINTA, CALIFORNIA 92253
w
T--,dy 4 4a Q"
July 23, 1996
78-495 CALLE TAMPICO — LA QU1NTA, CALIFORNIA 92253 - (619) 777-7000
-FAX (619) 777-7101
Master Pools
73-547 Highway 111
Palm Desert, CA 92260
ATTN: Bill Haneseck
SUBJECT: Setback Adjustment 96425
LOCATION: 54-659Avenida`Montezuma
This letter is to report approval of the subject setback adjustment application pursuant to
Chapter 9.188 of the City of La Quinta Planning and Zoning regulations, subject to
Conditions and according to the attached Exhibit A as approved
SETBACK ADJUSTMENT REQUEST: To reduce the rear yard pool setback from 5 feet
to 3 feet for a private swimming pool/spa. This request also incorporates a reduction in the
southerly side yard setback from 5 feet to 2 feet for the necessary pool equipment.
CONDITIONS:
1. Obtain all necessary building permit(s) from the Building and Safety
Department, and,
2. The pool equipment location as shown on Exhibit A shallmaintain a minimum
of three (3) feet from the property line of the subject property. If the 3 foot
requirement cannot be met, then the equipment shall be relocated
After review it was determined that:
1. This adjustment is consistent with the intent and purpose of the Zoning
Ordinance to allow development of single family houses and swimming
pools/spas in the SR Zoning District.
sba96-425
MAILING ADDRESS P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 ��Y'
2. There are special circumstances applicable to the property, including such
factors as size, shape, topography, .location and/or surroundings that justify
approval of the adjustment, in that the private rear yard area is smaller than
required under existing zoning, and maximization of the area between the
house, swimming pool/spa, rear and side property line necessitates the
adjustment in order to acommodate necessary equipment and adequate walldng
surfaces around the pool/spa for the occupants and/or guests.
3. This adjustment will not be detrimental to the health, safety, and general.
welfare of the community because the yard improvements will be privately
maintained and fenced to prohibit access to the improvements unless by the
owner's permission, and will be situated in the rear yard area so as to be as
unobtrusive as possible on the surrounding properties.
If you have any question, please contact me at 619-777-7069.
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
Wallace Nesbit
Associate Planner
WN
Attachment
c: Building & Safety Department
sba96-425
II J U L 1 y 1=0 U
U CITY OF LAQUINTA
PLANNING DEPARTMENT
S(/-} CASE N0: 96� ZS
CITY OF LA QUINTA FEE: $100.00
PLANNING & DEVELOPMENT DEPARTMENT
APPLICATION FOR SETBACK ADJUSTMENT
APPLICANT: Submit this form with two copies of a scaled site plan,
drawn to adequately depict the nature of the request. A nonrefundable
fee of $100 is required when the Application is submitted. Check must be
make payable to the "City of La Quinta".
If the Applicant is not the owner of the property, a letter must be
submitted by the owner authorizing the Applicant to execute this document
in his behalf.
PLEASE PPjRIN//T OR TYPE
APPLICANT/CONTRACTOR: M,9J1e/' I&ee DATE
CONTACT PERSON ( IF DIFFERENT) .C111 /�GIl cs�cK
MAILING ADDRESS 73 5y7
ss
(city
PHONE
-7
eIV ? 4
State) (Zip)
OWNER' S NAME: omr- G& cJ"G�7- PHONE %%/ - 38.3f
MAILING ADDRESS: SYJ #ue17l1R 1oille,241ne � owt�7 bt_ f 1z,5�a
(Address) (City) (State) .(Zip)
STREET ADDRESS OF PROPERTY: Sa �e
LEGAL DESCRIPTION OF PROPERTY: LOT ## -3 -rRAe` ^ P I O C/C a -]
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED: 2 �,ef��zn�... �N s��-K rz�t �Oc�(- s��✓J
/0411 r�t�v�/�/lllih/%- /�. SEi 3�F.GK ����% Tic- T 70 X14s 41/G U�fT
REASON FOR REQUEST:
JUSTIFICATION: No request for a Setback Adjustment shallbe granted
unless .it is determined that it is .consistent with the inten and purpose
of. this Ordinance; that there are special circumstances applic
cal
to the
property, including such factors as size, shape, topography, location or
surroundings that justify the approval of the adjustment of the setback
requirement, and that the adjustment will not be detrimental to the
health, safety, and general welfare of the community or be -detrimental to
property in the area of the parcel for which the adjustment is requested.
FORM.013/CS
4
65q P.O. BOX 1504
Building,-,� 78-105 CALLE ESTADO
Address 54 � AVMXi& Mootezilria LA QUINTA, CALIFORNIA 92253
Ir 14 sr r, - •.. ws •
Mailing
Address P.O. B= 2MB
City I Zip ITel.
Contractor
Sam
Address
Sam
City izip
State Lic.I City
& Classif. 397169 Lic. # 282
MFUM, Cflgr.,
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
7000) of Division 3 of the Business and Professions Code, and my license is in full .force and
effect.. Jl _ i�� '. e / r ;�, _
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 Busihess 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 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.)
0 1, 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:)
❑ 1 am exempt under Sec. B. 8 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
❑ Copy is filed with the city. ❑ 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 ($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 shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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 -of, this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant' l r ' Date
Mailing Address
City, State, Zip
HARD COPY
No. 002377
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774-264-a3
Legal Description Lot 3
Project Description SIMIn fm3.1y dwailjm
Dm. 1592
Sq. Ft. 430 No. No. DIN.
Size Stories Units
New EJ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$ 81,447.60
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
318.512
Const.
3719.00
Mech.
31.00
Electrical
70.12
Plumbing
69.00
S.M.I.
5.71
Grading
Driveway Enc.
20.00
Infrastructure
7 ,
1,2�2t1,.1
,La`Jt.* 1 T K ::E!;I
JsU
TOTALI3X
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 ermit
Validated by:
Validation:
A 5 7 6 0 6 10 't7 .4,18 U
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR.SO. FT. ®
CAR P. I SQ. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS /
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
P. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
f7 7 0 `_,
7
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
11PERMIT 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 GRADEROUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS /
SEWER OR SEPTIC)f
/
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. Z�'v
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
14FRAMING f{ F
FINAL INSP.
OOFING /,�0,t`v 7
f7 7 0 `_,
7
/
p!J
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ry
LATHING 7
MESH
CATION/SOUND
FINISH GRADING
/
�J&FINAL INSPECTION
v
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
4
H
U
w
s4 -1,65q �.
T
COUNTY OF RIVERSIDE, ENVIRONMENTAL HEALTH SERVICES DIVISION
PERMIT APPLICATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
/ < 4 L T
pplicant: Submit this form with four copies of a scaled plot plan (1-20 scale) drawn to)
Runty specifications required on the attached check list. A non-refundable filing fee of
30 is required when the application is submitted. Check must be made payable to the
Runty of Riverside
Building Department Application Log #
Name (Owner, Agent, Contractor, Etc.)
,rt' 1i < i X r, s e- <1 lr'/+S
Mailing Address
/1/, X 2 P 3 f
City_
State
r'/ ^/
Zip Code_
�� C' f Z
Telephone
I - ' 2 r' j
*Job Property Address
*City or -
*Legal Description of Prpty. (Lot, PM, TR)
Mt, n7fP<E.
,d : �:��;�ir /7� -
!C
*Assessor's Parcel No.
'Water Agency
Use of Permit lIJA ! Iry
`` `Lot `Size
- l,C
vr. 1-1.
1 6
SFD, MH Site Pre
Planning Case # Py 1-.279
J_? X 1,-(]
./�.r � � • • it / �7..t ��' % -i - B/�
Signature of Applicant Date
*The above information must be verified from Building Application
STAFF USE - DO NOT WRITE BELOW THIS LINE
Initial Date /
Certification of Existing S.D. System reqd. Yes[ ] No 1-1
WQCB Clearance reqd. Yes[ ] No[ -J
Soils feasibility report reqd. Yes[ ] No ['] i
Detailed boring report reqd. Yes[ 7 No f']
PA
Detailed contour plot plans reqd. Yes C 7 No r-1 1 -
0
H Staff Specialist approval regd. Yes[ ] NoC -] Lot Inspection Date
U
W _
Soils/boring report by _ Proj . # Date /
Soils Map Page 11 +A / Soil Type (ir Approved by I &I Date u / �F
rj
Type of System: No. of Bedrooms (1) Septic Tank Soil Rate Required
Existing New Addition Replacement /L�U'f/ Gals.
(2) Leach line sq. ft. Sidewall allowance Install Line(s) Leach bed
(Bottom trench area) ft.._rock/ Sq. Ft. Ft. Long,._, Ft. wide Sq..Ft�. of
per rerunning ft. with Min. "inches rock bottom-,__
N/A C J below drain lines area
Leach lines/bed-special design (3) Pit Diameter, No. Pit Seepage Pit total depth It?
for slope: Applicable ,ie[+.i- 6' C w--- Pits BI
N/A Overburden factor /(� Max. allowable depth C,�
x v�
W
7,
This application i$-approved`/#a%nAo&d for the design of a subsurface disposal s: -stem as
indicated on the accompanied plot plan using the requirements set forth in Section B above.
U A building permit is necessary for the installation of the above -designed system.
z
o Septic tank. and sewer lines must be _50' from any wells_ ' •'./A� / .1C'_ -
H (2) Leach lines must be 100' min. from any wells including expansion -area
Pq((3)•Seepage pits must be-15-0,1-min._from-any-wellsj.ncluding expansion area /�
--~ -�.
Sig,attire;oftHga,th,,Officia1 Date 7_ 6! , tVX
RECEIPT NO. `f / Issued by r C Date . / k
District: Riverside C ] Indio C T Hemet [ ] Perris[ ] Rancho Calif.[ ] Blythe[ ] /
Distribution: WHITE -Office file YELLOW -Applicant PINK -Bldg. Dept. GOLDENROD -Pending File
DOH SAN 122 (Rev. 2/86) '