BLDG (0309-196)54270 Avenida Martinez
0309-196
11627
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
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
o pensation, 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 /11
Date Signature of Owner,—: / _ s Z, r
C
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 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 s1=iall 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 inspectirfn purposes.
Signature (Owner/Agent) Date 5' ,
r
BUILDING PERMIT , PERMIT#
-1
DATE VALUATION LOT TRACT
09112420C 5721.40
JOB SITE
APN
ADDRESS M-270 AVM)J)A MMMNEZ
OWNER
CONTRACTOR/DESIGNER/EN (NEER
LRTBOWR K3IiJAMVIC
OiiJIM BtJTLD XR
54-270 AVE.Id7D.AMAMINW...
LA NQUiNTA CA 92253
USE OF PERMIT
GWJ?PAi, $t]I1 d322JC3
16 LF 3' BLOCk WALI, FRONT PROPERTY T.tTMI S LF & WALL
3TARTINO I V RACK'FROM P11, ALONG DRiV EWA,Y.
6 FT, WALL 15,04 LF
5 FT. IVALL 16.00 LF
ESMATED COST OF CON.`%CR'ETC7 O)l
721.40
PER71W FKK S'UIVI'I1+3'A tY
CONSTRUCTION FEE 101.000.418-000 ' 2L10
P 12 1003
t
CITY OF LA QUINTA
FINANCE DEPT.
SLTB-TOTAL CON3THii)'Ci 011 AND PIM CHECK
$21.00
IM9 PRE -FAD) rRES
$0.04
llurAL. MW- T VNES ME ti+CiW
$21.00
RECEIPT
DATEBY
DATE FINALED
INSPECTOIJ
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
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
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
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)
COMMENTS:
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as.an employer,and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may. be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under Stair
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814. - 1
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX: (760) 777-7011. O
'S SIGI)Y6EWRE/DATE
»Lj 1*.e-/)"Ve.
PROPERTY ADDRESS
� -3�� /ice
PERMIT NUMBER(s)
(:ii J
P.O. BOX 1504 No. 11627
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Moran BUILDING: TYPE CONST. OCC: GRP.
Address 54_220 Martinez A.P. Number
City Zip Tel.
la Ouinta, CA 92253 1 Legal Description
Contractor Project Description Foal. and Ana
Robert Ainsworth Pool Const.
Address
73-043 Sonr era
City Zip Tela
Palm Desert, 4A 922610 568-3180
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
C -a3 59Rb812741
Arch., Engr., Size Stories Units
Designer Ainsworth Pools New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Address Tel.
Sate
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I her h t I am licensed under 6roAsions of Chapter 9 (commencing with Section
7000) of,.D}iv ision 3 of'th}e Busiirmss a n'}d.,Pr6ff'essions Code, and my license is in full force and
effect. i \ , tAI.A,L) . /&tf•1V 1, .
SIGNATURE' Y + ' DATE
OWNER -BUILDER DECLARATION Estimated Valuation
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 AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars. (S500). Bal. Plan Chk. a. A
O I, as owner of the property, or my employees with wages as their sole compensation, will 7 6 Y Q 5
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. ` ( 0
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, Mech. ' ,
provided that such improvements are not intended or offered for sale. If, however, the building s
or improvement is sold within one year of completion, the owner -builder -will have the burden Electrical y+ 5
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 con- Plumbing
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 S. M. 1. 1.00
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
0 I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
f WORKERS' COMPENSATION DECLARATION
her b€ y affirmAhat I have a cgrtifi'Fafe of consent to self -insure, or a certificate of
Worker's Cof ensatiorr Insurance,, or a c6rVied-copy thereof. (Sec. 3800, Labor Code.)
Policy No. F I' i % p° Varfy, 1, > j
opy is filed wlthAe`city. O Certified copy is hereby furnished. .
TOTAL 290.05
CERTIFICATE EXEMPTION FROM REMARKS
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 y` N
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 Exemptionyou should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
1 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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO. FT ®
ESTIMATED CONSTRUCTION VALUATION $
NO. ELECTRICAL FEES
UNITS
MOBILEHOME SVC.
POWER OUTLET
NO. PLUMBI
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
A.C. UNIT
FLOOR DRAIN
MECHANICAL FEES
ROUGH PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
FINAL INSP.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GRADING
cu. yd.
$ plus x$
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
v'tT(
/f
/
/ /� 3 Gf% D�
REMARKS:
VENTILATIONfl
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
FOR: Rear yard encroachment for pool equipment and H.V.A.C.
condensing unit
IInWnTTTnMC .
1. A building permit shall be obtained from the Building
Department.
2. The equipment shall be 8 -feet from the rear yard property line.
3. The 5 -foot sideyard setback shall be maintained along each
respective property line.
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
special circumstances are: the property is 50 x 100 feet
which allows a reduced area to place the accessory equipment.`
City of La Quinta
Post Office Box 1504 • 78-105 Calle Estado
La Quinta, California 92253
Phone (619) 564-2246. Fax (619) 564-5617
LTRGT . 14 2 /CS Design & Production: Man. Design. 648.146-0772
T H
E C I T Y O F
AL
La ginta
1982 - 1992 len carat Decade
September 9, 1992
Santa Rosa Construction
Sub'ect:`
Mr. Jeff Shively
Setback Adjustment: 92-135
PO Box 1774
Location: 54-270 Martinez
La Quinta, CA 92253
-
APN: 774-254-002
Y
Legal: Blk 17 Unit 27
Dear Mr. Shively:
This letter is to report
approval of your recent application
for a
setback adjustment,
pursuant to Chapter 9.188 of the City of
La
Quinta Planning &
Zoning Regulations. The following
setback<`''
adjustment has been
approved subject to conditions and in accordance
with attached Exhibit
A.
FOR: Rear yard encroachment for pool equipment and H.V.A.C.
condensing unit
IInWnTTTnMC .
1. A building permit shall be obtained from the Building
Department.
2. The equipment shall be 8 -feet from the rear yard property line.
3. The 5 -foot sideyard setback shall be maintained along each
respective property line.
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
special circumstances are: the property is 50 x 100 feet
which allows a reduced area to place the accessory equipment.`
City of La Quinta
Post Office Box 1504 • 78-105 Calle Estado
La Quinta, California 92253
Phone (619) 564-2246. Fax (619) 564-5617
LTRGT . 14 2 /CS Design & Production: Man. Design. 648.146-0772
L
41
3. This adjustment will not be
detrimental to the health,
safety,
and general welfare of the
community or be detrimental
to
property in the vicinity
of the parcel for which the
adjustment is requested.
If you have any questions, please
contact the undersigned.
Very truly yours,
JER Y ERMAN
PLAN NG & DEVELOPMENT DIRECTOR
i
' T ousdell
Associate Planner
GT:ccs
Attachment: Exhibit A
Vis,
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78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 19, 1997
Moran
54-270 Avenida Martinez
La Quinta, CA., 92253
RE: Pool & Spa Permit #11627
Dear,Mr.. Moran
The purpose of this letter is to inform you that your Pool & Spa Permit #11627, for the project
54-270 Avenida Martinez, has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Buildin & Safety Manager
Daniel P. Crawford r.
Building Inspector I
cc: file
MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253