9604-016 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
{ LidensL k`t Lic'.'Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is jissue(tM,yj1workers' compensation insurance cagJpr)%.,tpolicy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the 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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with t r Islonss•
Date:
Applicant-
.,,,�—
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3.706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each'person at
whose request and for whose benefit work is performed under or.pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or'cessation of work for 180 days will subject permit to cancellation.
I "certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)Date
� PERM'<# °°NTR°`"
BUILDING PERMIT3058 96114-016 3 0 5 8
DATE�� VALUATION pi�q��i.%�1 LOT. .-TRACT
JOB SITE ADDRESS 5-2-5711).��V�.,C'�F,I.�SA .� AMZ
APN M3-281-04
OWNER
CONTRACTOR /�DESIGNER
.
Y{{ N.i0if,thCK
�/ENGINEER
32570 AVENIDt1. li.:iAREI
43373 MADISOt-1 ST.
I.A QUINTA. CA 42253
INDIO Cllr. 92202
.
r
(619).347-50-59 ,.. .. CBLff 1 ! 5 S
USE OF PERMIT
POOL ANUDOR SPA
POOL ANE) 55LF N GAfIWEN BLOCK iVli.LL -•-
___,..•
.� �? � f > l �"' i.�• r ;� / <�'". t,• !`f t '�,` ,i r; ..,;. sr.� JFt, �r�s�t1� .
.ti,�
,
[JC9l�..��i{�ANj11/l}.it.:if�f�. M(1izr�j
'PLAN CHECK Ff-,
air ct1 .� .fit FUR POOL 102-000-121.-000 ;60
ELECTRICAL P M —1100-1 101-000_420�000 V1 i.00
Lffldtf9t1KG" lit; -- V*4001. 101-000419-000. $27.00
$180,N)
SIM-'1'0TA L COMMUC'iTON ANT) PLAN CIMC F,
$38.1.30
L1 S3 Pis.R4AA1D I+.ES
$0.00
UYUkti PEICNIi ' I,. -E,` 3UENO
RECEIPT _
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. TestvV_9Yf_6_'
Final
Gas Piping
PLUMBI G APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
L�
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
April 3, 1996
Cv u�i�Gv
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
Western Pools
43-375 Madison Street
Indio, CA 92201
SUBJECT: SETBACK ADJUSTMENT 96-400
LOCATION: 52-570 AVENIDA JUAREZ
Dear Sirs:
This letter is to report approval of the setback. adjustment application pursuant to Chapter
,9..188 of the City of La Quinta Planning and Zoning regulations, subject to Conditions and
according to the attached exhibits.
SETBACK ADJUSTMENT REQUEST: To reduce the front and side yard setbacks from
5 -feet to 3 -feet for a private pool.
CONDITIONS:
a. Obtain a building permit from the Building & Safety Department, and
'b. Install perimeter five-foot high fencing.
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 special circumstances are (a) small front yard, and (b) increase
separation of the pool to the home.
sba96400
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 `'`(J
3. This adjustment will not be detrimental to the health, safety, and general
welfare of the community.
If you have any question, please contact me at 619-777-7067.
Very truly yours,
,ARY HERMAN
aY DEVELOPMENT DIRECTOR
.
DELL -
ner
GT.
Attachments
c: Kelly Tropple, Building & Safety Department
0
sba96400
CASE NO: yW
CITY OF LA QUINTA- FEE: $100.0.0
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.
A�PLEASE PRINT OR TYPE
APPLICANT/ CONTRACTOR: ICSI��rt �oo� S DATE
CONTACT PERSON (IF DIFFERENT)
MAILING ADDRESS: g -s - 37S Plefd/Sc4 /P
(Address) (City
PHONE
CX , f Z Z-4,1
Ts—tate)— (zip)
OWNER'S NAME: A I Ayi I o l l o G k - PHONE
MAILING ADDRESS:
(Address) (City) (State) (zip)
STREET ADDRESS OF PROPERTY: .5 2 5%D _—�Ua re 7—
LEGAL
LEGAL DESCRIPTION OF PROPERTY: LOT #
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED: 3� 5
r SWi
TRACT
Si ►7E � fIZoN-t' '
REASON FOR REQUEST: SNA11`-
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
L
I
A,/