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13483 (RPL)77245 Loma Vista 13483 4 w .r P.O. BOX 1504 N 0 . Building 78-105 CALLE ESTADO Address 77-245 Loma Vista LA QUINTA, CALIFORNIA 92253 Owner Ernst W. florin Mailing Address City Zip Tel. California Pools and Spas Inc. %ress Boardwalk A--2 Zip Palm Desert, dA State Lic. & Classif. C53 185102 Arch., Engr., Designer Address 12211 A40-9000 City Lic. # 355 Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby -affirm that I aiM,licensed upder provisions of Chapter 9 (commencing with Section 000 o D'w_`` 3 –r— he'BusinesrsXan;Pr ,Te`ssions Code,tand my licens s in ull fors a0d fact. = , 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,Susiness 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 rive 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 or completion, the owner -builder will have the burden o1 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 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. & 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 C 7 Policy pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) N Company 1 eorpy 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. 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 —Date— Mailing ateMailing Address City, State, Zip BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Pool and Spa Sq. Ft. Size No. Stories 23483 No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Itstlmatea valuation $18P400.00 PERMIT Plan Chk. Deg Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure AMOUNT 122.85 1889.00 24.00 45.00 27.©0 TOTAL 407.85 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback fr m Center Line Rear Setback froms Rear.P_rop. Line Side Street Setback from (Center Lines -- Side Setback from Property Li /-=— FINAL DATE Issued by: Validated by: Validation: h. CONSTRUCTO--1 ESTW_ATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING 2ND FL. SQ. FT. HEATING (ROUGH) YARD SPKLR SYSTEM FOR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. HEATING (FINAL) DRINKING FOUNTAIN. SQ. FT. ® GAS (FINAL) 9s URINAL _ ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GRADING CU. yd. $ plus x$ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM FINAL INSP. KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAR. FIREWALL GAS PIPING PERMIT FEE PERMIT FEE I 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) 9s 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 A REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION / CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL CASE: 95- Location(e) Reque'st (9) --sion, +4,, e4 0'. PrI fr A_ I . %n Your setback adjustment application is hereby approved, subject to the following conditions: Conditions: 1. Obtain a building permit from the Buildingand Safety Department. 2. The other Zoning Code provisions shall be met. .3. if ground excavation is required, please contact Underground Service Alert (USA) at 1-800-42274133.- The service is free of charge provided USA' is given at least two working' days'- notice. 4. Additional Conditions: After review -it was determined that: 1. This adjustment is consistent with the intent and purpose of the Zoning Ordinance. 2.. There.are special circumstances applicable to the property, including such factors as size, shape, topography, location or .surroundings that justify approval -of the Adjustment. These circumstances are: f_'Vk-I) k% -A .62a. t.=.A_ / . , - N . Tha your cooperation. Si 6 ely, t6vu1ty/ Development. Depart Attachments c: Building and Safety Department 0 Families M NMI I Ilk, 1"W ®®-WR VIA" —mow-, lwv,.;.Swn MWIi , I * ' p pip '111 I i a MIN m Mim I im, UV21 W"j.- 'q PN