15555 (RPL)Building
Owner
P.O. BOX 1504
78-495 CALLE TAMPICO
52--770 Ave. Carta za LA QUINTA, CALIFORNIA 92253
t1r. & Mrs. Triuisic
Mailing
Address same
City Zip Tel.
�a Quianta, Cis 92253
'Contractor '
Family Poolz Construction
Address
53=-300 Ave. Ramirez
City Zip Tela
La Quinta. CA 92253 564-3655
State Lic. City
& Classif. C53 3658996 Lic. # 2893
Arch., Engr.,
Designer
Address Tel.
City(Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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 Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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).
O 1, 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 knprove for the purpose of sale.)
❑ I, 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. O 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($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.
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 Address
City, State, Zip
BUILDING: TYPE CONST
No. 15555
OCC. GRP.:
A.P. Number
Legal Description
Project Description
P001
3' rear' vard setback reduction.
for gaol Per SB, 95-331
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 I erml
.. �I �
Validated by:
i
Validation: I 1111 1) r; lor1lrr-
By
��
i
Estimated Valuation
$8, SSE}. QO
PERMIT'
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
% •
Const.
•
Mech.
Electrical
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
l 4 •
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 I erml
.. �I �
Validated by:
i
Validation: I 1111 1) r; lor1lrr-
By
��
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
► `- _
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. @
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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
A
SETBACK
GROUND PLUMBING
UNDERGROUND JJ
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
1 f/ 9
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
�J� � %
�, �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
MEMORANDUM
ss .
CASE: Lac ation (a) : .5-'_'-,-77C 4te_
Request (s)
Your setback adjustment application is hereby, approved, subject to
the following conditions:
Conditions:
1. Obtain a building permit from the Building and Safety
Department.
2. The other Zoning Code provisions shall be met.
3. If ground excavation is required, please contact Underground
Service Alert (USA) at 1-800-422-4133. The service is free of
charge provided USA is given at*least two working days,'
notice.
4. Additional Conditions: 4?,W , �_,s , --IL•
^
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:, y� .4 _, .cam /
Thank you for your cooperation.
Sincerely,
unity De elopment Dep tment
Attachments
c:.B ildinq and Safety Department
3'
Calle Nogales
_..... 11'G'
3'
Existing Concrete
2'f
TERVISIO RESIDENCE
52-770 Ave. Carranza
La Quinta
Rear Property Line
OF -71
o�
Colored Salt Concrete
1/4 =1' EXHIBIT i¢
CASE NO. 9 j
�Sti E?i Fn DIVISION
r
YwnGG�i �"
v
Construction
Pools Spas Fountains
(619)564-3655
Lic. #658996
CASE NO:
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 th3; dacument
in his behalf.
PLEASE PRINT OR TYPE
APPLICANT/CONTRACTOR : C)zJ DATE
CONTACT PERSON (IF DIFFERENT) PHONE Z 3.
MAILING ADDRESS: 'S� --io0 J t,, Pc em /Ar,?--
(Address
ty
tate) (Zip
OWNER'S NAME :---1/Z_C�iS �PiP� i�/,S✓l� PHONE
MAILING ADDRESS:
s)
City
STREET ADDRESS OF PROPERTY :Z7�✓�
LEGAL DESCRIPTION OF PROPERTY: LOT 4
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED:
REASON FOR REQUEST:
State). ' (Zip
04�.1 M
gin) �5 / S,e
0
JUSTIFICATION: No request for a Setback Adjustment shall be granted
unless it is determined that it is consistent with the intend and purpose
of this Ordinance; that there are special circumstances applicable 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
July 10, 1995
City of La Quinta
La Quinta, CA 92253
TO WHOM IT MAY CONCERN:
Please allow Don Early, of Family Pools Construction to execute the attached
"Application for Setback Adjustment" document on our behalf.
Thank you for your assistance.
Javier and Terri Triviso
52-770 Avenida Carranza
La Quinta, CA 92253
(619) 564-4038
q fad
M
�... 3'
00
6� �q
e_ _.._ . _ ._...,._ .. _ ........j .... _ ... __ 25•� __....
11 Per /
9TY F LA l� l �lTA
BUR INC & SAFETY DEPA TMENT
CONDMON aLLY
C Et ED FOR CONS RIUCTI N
Existing Concrete I SUBJECT TO INSTALLATION AS PER
x
AND ALL APPLICABLE CGDE
DATE BY
TRIVlSIO RESIDENCE --
52-770 Ave. Carranza
La Qulnta
Construction
Pools Spas Fountains
(619)564--3655
4 Lic. #658996