15040 (RPL)Bulding
Address 48--657 Paseo Tarazo
Owner Her mar
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Mailing Same
Address
City Zip Tel.
La ¢ulnia. .92253 771-2635
Califorhia Vools & Spas Inc.
Address .
41--914 Boardwalk A-2
Zi
Cit�alm DeSert p C:aA 92211 TeS40-94fl -
State Lic. City
& Classif. , C-53 656128 Lic. # .. 355
Arch., Engr.,
Designer
Address Tel.
City Zip State
C. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affi thatf am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3,of the Businesg-a—ndProfessions Code, and my license is in full force and
effect. / j
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`
r 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,Business 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 rile 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 Profession 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 penally of not more than five hundred dollars ($500).
❑ 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 improve 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 contractors) licensed pursuant to the Contractor's License Law.)
O 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.)
PolicyViD. Company
,Copy 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
c
Date Owner
NOTICE TO APPLICANT: h, 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 if work thereunder is suspended for 180 days.
I certlfy that I have read this application and state that the above information is correct.
I agree to comply with all cityand 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
No. 15040.
LDING: TYPE CONST: OCC: GRP
P. Number
,Legal Description
Project Description Poo and spa
Sq. Ft. No. No. Dw.
Size Stories - Units
New ❑ Add ❑ . - Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation ' $13 t 700. QO
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
99.45 .
Const..
153.00
Mech.
24.00
Electrical
45.00
Plumbing-
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
348.45
HEMARKS
ZONE: BY:
Minimum Setback Distances- J
Front Setback from Ctsn r e
Rear Setback frornr a rop. e
Side Street Sed om C J e
Side Setback/Ir PrOjoy y Lin
FINAL
Issued
Validat
Validat
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBNVi3 FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ, FT, ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING4�7 V71
/
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
I WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FRAMING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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
SETBACK
GROUND PLUMBING
NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING4�7 V71
/
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI 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 INSJ..,,/
FINAL INSP.
GRADING
cu. yd.
-Plus-x$-=$
LUMBER GR.
FRAMING
ROOFING
ax
N�
p
/ L'
( (�1\►Ij�_)
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
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MEMORANDUM
CASE: Location (s)
Request(s):
eoJ
Yoursetba6k 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 1-800-422-4*13.3. The service is free of
cha ' rge provided USA is given at least two working days'
notice.
4. Additional Conditions: AP Pr PWPr,40,:1,A
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, topocraphy, location or
surroundings that justify approval of the :adjustment. These,
circumstances are:
Tha4you . or , your cooperation.
Sin dly
velopment Department,'.
Attaphments
c: Building and Safety Department
CASE NO: 41.5_r 314
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 thl-s--doeument
in his behalf. J /."z\
PLEASE PRINT OR. TYPE - J1_7:X?
APPLICANT/CONTRACTOR:(r%: rL Aa C V1 DATE S
CONTACT PERSON ( IF DIFFERENT.) PHONE
MAILING ADDRESS:
ss
OWNER'S NAME:
(City
(State) (Zip)
PHONE
MAILING ADDRESS:
(Address) (City) (State) (zip)
STREET ADDRESS ' OF
PROPERTY: ------ -
-
LEGAL DESCRIPTION '
OF PROPERTY: LOT #
TRACT
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED:
JUSTIFICATION: No 'request for a Setback Adjustment shall be granted
unless it is determined that it is .consistent with the i_-itend.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 adjustmen= of the setback
requirement, and that the adjustment will not be det-rimental 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
ARCHITECTURAL VARIANCE REQUEST
Unit • Date u}�'Z�-g'r'-
Street Address 41NOG-1 /!k��Ea�-f A►2�,
Local Phone �1"1 �.Z.%3S Other Phone
To the Architectural Committee:
we, the undersigned owners, request your approval of the
modifications p.roposed.an the reverse. side of this. form.
Attaehed are .drawings of the work to be done; ty-pes of
material to be used are indicated on the drawings. we
understand tnat building permits for home improvements are
required by the City Of.:.a Quina and .that the cost of the
permits and responsibility of obtaining permits and
subsequent inspections will be borne by 'us.
we ackowledge ,that all ap'p.ioved changes in the' original
design will be at our expense; that any :damage to or
relocation 61 existing sprinkler systems, underground
utilities, building structure and exterior .landscaping or
other damage resulting from construction of tc,ese permitted
improvements will be at our expense; and that maintenance,of
the permitted improvements will be at our expense.
J
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Signature of, all owners:
r
Please przvide as much detail. as possible 301 that .t.ha
Committee may consider approval without de'_ay!
• �ooL-S /�N� SPS, S..
• ` FLAN M— � o � � E�'i' MJ G►� ,.
The:above proposal has been reviewed by the A::hitectural
Committee and las been:
APPROVED REZE.CT--O P_NO/NC FURTHER
O fNF0RMATIOON'
O
Ca Mtn ents.:
Vz,v �/,�j
C mmittea Committee Commitee
ember - .04Memoer
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