15317 (RPL)Buildif,g
Address 78-55
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Mailing
Address16 Ta for .Ave
City Zip Tel.
Pala Desert192260
Contractor
Address
Zip I Tel.
State Lic.I City
& Classif. Lia #
Arch., Engr.,
Designer Carlos Elias
Address Tel.
City (Zip (State - 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 I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness 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 rite 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).
'IN' I, as owner of the property, or my employees with wages as their sole compensation, will
dIMhe work, and the structure Is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's- License tow 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.)
O 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.)
Polic No. 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.)
1 certify that in the performance -of thg work for which this permit is issued, I shall not
employany Parson in any manner so ae�§s to becomubject to the Workers' Compensation
Laws of California f r f / f //
Date Owner rt` �•�'
NOTICE TO APPLICANT: d, 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.
1 certify that 1 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
No. 15317
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description POOIL- SPci
OCC. GRP."
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation7,500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
�`� •
Const.
=� •
Mech.
VU
Electrical
U"0
Plumbing
a I • , u
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
• ��
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback frog i enter ine
Side Setback from Prop y Lirae!�
FINAL DATE IN
Issued by:
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUf1ABINu FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE I
I
'BONDING
YARD SPKLR SYSTEM
2ND FL. i SO. FT.
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
/ METER LOOP
/
HEATING (FINAL)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
J TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
WATER HEATER
SERVICE
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
] MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN j EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALLI FLOOR . SUSPENDED
FIRE ZONE ROOFING ' J
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE }
IKITCHEN 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:I
SO. FT. RESID ® 1+/o c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
]
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTALI FEES
1
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE I . . PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK }
GROUND PLUMBING
`UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE I
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.IEOUIP.
REINF. STEEL j
GAS (FINAL)
J TEMP. POLE
GROUT I
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
,GRADING
cu. yd.
$ -Plus-x$-=$
•
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
/ "lYIN
REMARKS:
VENTILATION
FIRE ZONE ROOFING ' J
FIREPLACE }
SPARK ARRESTOR
GAR. FIREWALL
LATHING J
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL 1
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL !
� �Qur«rw
MEMORANDUM
9s
SBH
CASE: 9r,' -..3a' Location(,) 5;: u C3
Request (s) :(D e.. S, o 's---- S 4-0
3'
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:
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: .QjA-rcj�>
Tha k you for your cooperation.
S' rel
X22
Attachments
v�o
felopment Devi
c: Building and Safety Department
CASE NO: 3� 3 -
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 this document
in his behalf. 33 —
1
PLEASE PRINT OR TYPE.. 1,
APPLICANT/CONTRACTOR: [b n LA yy, 0/
CONTACT PERSON (IF DIFFERENT)
MAILING ADDRESS: ( i9-
(Addre s)
City
PHONE
re la -224
tatd)' (Z
OWNER'S NAME: 51(1^&- PHONE
MAILING ADDRESS:
(Address) (City) (State) (Zip)
STREET ADDRESS OF
PROPERTY: 7
S `S
/96URG? c7
LEGAL DESCRIPTION
OF PROPERTY:
LOT #
/0 5- TRACT
ASSESSOR'S PARCEL NUMBER: 313 ,3 - no
ADJUSTMENT REQUESTED: S// /�C/4-✓;' ?`rl��✓� C, c�/'`
0
REASON FOR -REQUEST:
/oo/ /5
4P Gi ,-
ME
CAI
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
10
S
9 �QoL CcQuiP T1`�
A/C
220✓
ry c �L
2 OOA
5e, lee
1`} ovs
PPoo Lt5 M O
ce4airr 3,v2 C.00\c re?e Z 6
D45:c-t< w/ SACT f)Q ISH
r -/o. -f.)L ocic..
A/C Fo
Ll
4c;49A)C4,
2 OOA
P6.L fi s'MtA
c40T 3,V2 C O fkC rGtC
D&-cl< +&/ SAcT flQ'SH
'ProPoseD
(�ouse �r
OF LA QUINTA
BUIL ING SAFETY DEPARTMDftw"',-�'
_ ONDITIONALLY I'bo
D FOR CONSTRUCTION q -
SUBJECT T 1" 'AL! ATION AS PER Ve 5 r+ 5to
AND 7LA;PLICA L
DATE F1n Ia vS
T�
I
�ro�D
'PeoL
N
72-11
L
o
rp*r tft# e�
'ProPoseD
(�ouse �r
OF LA QUINTA
BUIL ING SAFETY DEPARTMDftw"',-�'
_ ONDITIONALLY I'bo
D FOR CONSTRUCTION q -
SUBJECT T 1" 'AL! ATION AS PER Ve 5 r+ 5to
AND 7LA;PLICA L
DATE F1n Ia vS