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14682 (RPL)P.O. BOX',1504 Building 52-394 Ove. .waren LA QUINTA, CALIFORNIA8-495 CALLE CO Address 922253 Owni�r Wtvid Miller Mailing Address CityZip Tel. ( Contractor Pddiftc Trades" Address Same City` , Zip Tel.: State Lic. , City & Classif. 8 425381 Lic. #. 1955 Arch., •Engr., - Designer Address Tel. City Zip State Lic. # L��tccnstcu CONTRACTOR'S�D,ECLARATION ' ��I hereb affjr .that 1, licensed under provisions of(,Chapter 9 (commencing with -Section 77000)rof ision 3 oft Business and Prof@ssions Code, and.my i rise is in full force and ' ►eftfec' \J` �'4• *"�...�, SIGNATU l 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 -pr county which requires.a permit to construct, after, improve, demolish, of 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 Profesiions Code, or. that. he is exempt therefrom, and the basis for the alleged exemption. Any violation, of. Section 703 1. 5 by 'any applicant for a permit subjects the applicant to a civil penalty. of not more than rive hundred dollars ($500). • . ❑ 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, Buisness and• Professions Code: The Contractor's License Law does not apply to an owner of property who builds or 6mproves thereonand 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 contractor(s) (sensed 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�affirrn that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3600, Labor Code.) Polic��y��Nir 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 anyperson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: M, 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. Thisis a building permit when'propedy filled out, signed *and validated; and is subject to expiration if work thereunder is suspended for 160 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 No. 14682 BUILDING: -TYPE CONST. - OCC. GRP. A.P. Number Legal Description Project Description Pool — no .heater .50.! 9i 51 high_ garden wail J 3' side and meront yard adjustment approved 95--288 Sq. Ft. No. No. Dw. Size Stories Units New 0 Add 0 Alter O " Repair E Demolition ❑ Estimated Valuation PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical S.M.I Driveway Enc. Infrastructure TOTAL REMARKS' 083.00 @4 7,000.00 AMOUNT ..05/64.35 39.00 24.88 45.00 27.00 304.35 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from RearaProp. Line Side Street Setback,fromC nteerr Line Side Setback from Property IL f e� FINAL DATE fNSPPC OI 4 Issued by: Dat€ Validated by: .i Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES a 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P.SO. FT. GAS (ROUGH) DRAINAGE PIPING Ili WALL SO..FT. OTHER APP.IEOUIP. DRINKING FOUNTAIN. SO. FT. TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. 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 SPARK ARRESTOR SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR p 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 PLUMBINGyf� �7 UNDERGROUND,. 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 APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM ' WATER SYSTEM GRADING cu. yd. t $- plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING /} �/ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION 7� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 1 6 Ti hf, 4 4Q�rw MEMORANDUM CASE: 1715-a89 Location (a): 5�? - Request(s):1c,a� -f-r�,_;- .; �1.9v�--�✓� f D � � i�-- C� � J c�iQ c• a Your,setback adjustment application is hereby approved, subject to the following conditions: Conditions: 1. Obtain a building permit from the Building and Safety Department. 1 2. The other Zoning code 'provisions 'shall be met. 3. If ground excavation is' required, 'please contact Underground 1- Service Alert (USA) at -800-422-4133. The service is free of charge provided USA-is.tgiven at' least, two working days,' notice. 4. Additional Conditions.,, ' 1 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: „�w Lam- c� —;L/ Thank you your cooperation. Sinrel , evelopment i Attachments -Department �c:-Building ,and Safety'CK�� R MINIMUM AR ALL GATES To . HIGH By AND SELF LA BE SELF: LATCHING, ING CA TOP LA�ni BU/LD/N - A Q G & 7- U/N-FA ry ,l 11 . Lj�-Dfl C�JEC T No DA TE7-p�9i� ��� lls:D. 1 N , AM i1 , !\. �i D� -t o D100,El DDD UT100-a Jv- cam_ . APPR LANNING & DEVELOPMENT DEPARTMENT BY _..._._UA. E EXHIBIT �- CASE N0.