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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
3481(>X CS -3 13 V 14190
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 3700 of the Labor Code, for the performance of the work for which this
permit is 4s"S' 64th My Wdrkers' compensation insurance carp 6,r4,8 tpblicy 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: Applicant—
Warning:
_ ' "
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 4bove-mentioned property for inspection purposes.
Signature (Owner/Agent) , ."' {""" Date f.
PERMIT # CONTROL #
BUILDING PERMIT
()t►tMI11115 3277
DATE 1/7/9(, VALUATION SI0,;5{Ni 00 LOT TRACT
JOB SITE
ADDRESS Sir -965 AVENIDA C;ARKANZA.
AP" 773-X72-024
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JAMES C' CHI LKNAP
�tirEKrfs"RN 1'L�C?t.S
54-965 AVE NIGAC_ARRANZA
43375 MADISON 51'
1.AQIJIKl'A('A 92"2 3
IND10 C"A 02202
ic;la13=17-5ft5`1 CF31,ff 11S!
USE OF PERMIT
!'t.XA, AN010K SPA
fN)OL AND SPA tjNt-Y
V-STIMATED (.'OST OF (AIN!r; RIJOVIN
101W.1HI
PERMIT 1<'VY SUMMARY
(4,AN C14ECK 11T: 1t11-00(1-139-318 $81,90
(:0Ny'7RU('I'1QNFEN 101-000-415-000 $126.00
MFC HAMC:AL IT I -- PCK)L 101-000-421-000 5211,00
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t LIX711ZICAf. FTg. -- INJOL 101410(142049)(1 545,00
(y1,M41INC1 F`.M--11(XX1 t01 -(XX) -419-(X)0 12700
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SUB -1C1 AL CONS"CKULMON AND PLAN CHECK
33!13.?D
L1;SS PRIE MI3 FEE'S
$0.00
TOTAL I"ERM ' Fig KS Ul IF, NOW
$303.90 ;.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
.41
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
44 4
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
6
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)
R4
b66405
May 6, 1996
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - 1(619) 777-7000
FAX (619).777-7101
Mr. Allen Elkins
Western Pools
43-375 Madison Street
Indio, CA 92201
SUBJECT: SETBACK ADJUSTMENT 96 408 (BELKNAP)
LOCATION: .54-965 AVENIDA CARRANZA
Dear Mr. Elkins:
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 setback from 5 -feet to
3 -feet for a private swimming pool/spa.
IN 1 1 ►
A. Obtain a building permit from the Building & Safety Department, and
B. Install perimeter five-foot high fencing with 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/spas 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
S
MAILING • ADDRESS - P.O. BOX 1504 LA QUINTA, CALIFORNIA 92253®��
I
W` greater -separation is needed between the house and swimming pool and spa to
provide adequate walking 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 back 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,
JERRY HERMAN
.COMMUNITY DEVELOPMENT DIRECTOR
G TROUSDELL �• �+
A crate Planner
GT.
Attachments
c: Kelly Tropple, Building &' Safety Department
sba96-405
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Sys 9Gs ��e. �Ar�a� za
® ALL APPLIUBU
DATE � 7 �fo BY
Pool
ETD
CUSTOM POOL/SPA BUILDER
SERVING THE DESERT AREA FOR 15 YEARS
ROCKSCAPE SPECIALIST
347-5959
P.O. BOX 1047 - INDIO LIC. x348768