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ENSED CONTRACTOR DECLARATION
^-rrieesi-Nc��a4"tr 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 Cull force and effect.
License p 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
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 37QO�ofghe��abor Code, for the performance of t0e�wor�for.�which this
permit is1iss`ued. 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 shall 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: ADDlicant
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 inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT# CONTROL#
atCril6(I:�_
3491,
n
DATE 0012196 VALUATION •�•� LOT Y" TRACT'S
JOB SITE SJ -405 ANIL C,A1(.H*.P TA
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DAVID MILLER
PACIFIC TRADES
-53-405 Cr\RRE NZA
P'0. BOX 722-
1A, QUTNTA CA 92253
) -A. QU.INTA CA 921253
-W-0273
(619)MA-027: CAL# 1951
USE OF PERMIT
F(-KJ1, .ANI)/Uk SPA
1.1 F "V t Y 28F"IJK>01. CYNI X
PERMIT Fff,ES }119MARY
i�'I.AN �'311i FEL: -11014)W419-319 $52.65
C(3NSTKvrC"rloN FEE .101.000.418 -OW $81.00
MECIIIANICAI.1rk:.---- MAX' 101tA-421.000
F IXC"rR lcty, IFF, -- K_X- I. 101-0(;()-420-000 $45-00
Co
PIAINIVIT O F ER --1"N. 1014)00-419-000 $217.00
CI rn
2
0
Sr r -TOTAL rONS'f'17UC`"IiON AND FLAN CHECK
29 ca5
1: US 11RE-PAID PUS
$0.00
1'(,Vf A L PER F$: IN 01 NOW
$229.65
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
St ,
Combustion Air-
Rooti§qck
Exhaust Fans
I 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
BLOCKWALL
APPROVALS
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
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)
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` - 78-495' CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 77'7-7101
June 11, 1996
David Miller
Pacific Trades
PO Box 722
La Quinta, CA 92253 .
SUBJECT: SETBACK ADJUSTMENT 96-418
LOCATION: 53-405 AVENIDA CARRANZA
Dear Mr. Miller:
i.9
This letter is to report approval of the 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 exhibits.
SETBACK ADJUSTMENT REQUEST: To reduce the rear yard sideyard setback from
5 -feet to 3 -feet for a private swimming pool.
CONDITIONS:
A. Obtain a building permit from the Building & Safety Department, and
B. The pool shall be fenced (minimum five-foot high) and have self-closing gates.
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
in an S -R District.
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 in that the private rear yard area is small, and
sba964 18
j.
MAILING. ADDRESS - P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253 "�
J
greater separation is needed on the north side of the swimming pool for
outdoor recreational needs of the residents and/or guests.
3. This adjustment will not be detrimental to the health, safety, and general
welfare of the community because the rear yard improvements will be
privately maintained and fenced to prohibit access to the improvements unless
by the owner's permission.
If you have any question, please contact me at 619-777-7067.
Very truly yours,
DEVELOPMENT DIRECTOR
C���USDELL
Ass t' P anner
GT.
Attachments
Lc: Kelly;._T_ropple;�Buuifd=i-ng &'Safety Department ----
sba96-418