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
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APPR LANNING & DEVELOPMENT DEPARTMENT
BY _..._._UA. E
EXHIBIT �-
CASE N0.