14580 (RPL)Building
Address
.Owner
44
P.O. BOX 1504 No. 14580
78-74S Sagebrush 78-495 CALLE TAMPICO .�
LA OUINTA, CALIFORNIA 92253
Ron Sza71.ay
BUILDING: TYPE CONST. OCC. GRP.
Mailing - Same � 1'
Address
A.P. Number_
CityZip Tel.
La Quinta, a 92253
Contractor
Sunair Pools
A�ddrys .... $35
City l.
Palm Desert, A 93251 Te568-4014
State Lic. City
& Classif.. C53 397252 Lic. #
Arch.; Engr.,
Designer•
Address Tel.
City lZipState
I
Lic: #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I 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 l 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
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
Me provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 9 of the Business and Professions Code, or Nat. 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 or not more than rive 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 or 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
or proving that he did not build or improve for the purpose - of sale.)
O 1, 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 or property who builds or Improves thereon, and who contracts for
such projects with a contractors) Qcensed 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. .❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the - permit is for one hundred dollars .($100) valuation
or less.)
1 certify that in the performance of thp.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: ff, after making this Certificate of Exemption you should become
subject to the Workers' Compensatkm 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 3708 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 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
Legal Description
Project Description Pool and Spa
3' rear yard and pool equip. setback
approved 95-282
Sq. Ft. No. No. Dw.
Size • . Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ ~Demolition ❑
stimated Valuation
$12,700.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
93.64
Const.
144.00
Mech.
24.00
Electrical
45, 00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
333.60
REMARKS
ZONE: BY: �•--"�
Minimum Setback Distances: ?:
Front Setback from Center Line
Rear Setback, from Rear Prop. Line
Side Street Setback from Center Line
Side S.etback.from Property. Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SQ. FT.
STORAGE TANK
YARD SPKLR SYSTEM
SEWER OR SEPTIC TANK ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH) METER LOOP
HEATING (FINAL)
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. S0. FT.
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
SO. FT. ®
LUMBER GR.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION
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. 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)45TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING.
cu. yd.
$ plus x$
.
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
A
ll-FIREPLACE1
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
MEMORANDUM
CASE: 95"- M2- Location(s) : 0/4 `4
Request(s) :
v
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,cont'act 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: 3 �f/�. C tc�� 52l ,&&�o% aZ &46 j
�t4(,L. �X Y� Crr�J.GO . l.•.► r �.. r,� / ^'� .�iYJ�SG� p� / JYt�� / /7`7J ��ri
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,psize, shape, topography, location ,or.
surroundings that justify approval`of the adjustment. These
circumstances are: �'Hg� Fz;g,,Lg,Q�
Thank_you for.your cooperation.
Sincly,
Department
Attachments
c: Building and'Safety'Department
tt
APPROV P "ING. & DEVELOPMENT DEPARTMENT
By DATE,
EXHIBIT
CASE NO.
i(
iiL6
30-0
0,414-
516
0
CITY OF LA QUINTA
PLANNING .& DEVELOPMENT DEPARTMENT
APPLICATION FOR SETBACK ADJUSTMENT
CASE NO: /� Z
FEE: $100.00
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 Quintal,'.
If the Applicant is not the owner of the property, a letter must be
submitted by the owner. authorizing the Applicant to execute this document
in his behalf.
PLEASE PRINT OR TYPE
APPLICANT/CONTRACTOR: 2 '0/VY4 i2 �
CONTACT PERSON (IF DIFFERENT) L_,, L z
%J
MAILING ADDRESS:
(Address). (City).
DATE
PHONE
State
2.L
OWNER'S NAME: AJ Q S Z_ a/ PHONE
MAILING ADDRESS: _ 2 ✓'u Lig CX lv�` lig' 2 z J":�
'(Address) (City) (State) (Zip)
STREET ADDRESS OF PROPERTY: ' 7.yS S Lt;]2�
LEGAL DESCRIPTION OF PROPERTY: LOT # TRACT
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED: 5�..
SMA
REASON FOR REQUEST:6k-
1,��1-
**************************************************************************
JUSTIFICATION: No request for a Setback Adjustment shall
t be granted
unless it is determined that iis 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