14988 (RPL)P.O. BOX 1504
Building 78-4.95 CALLE TAMPICO.
Ad�erm 53-1130 Ave • c uatez LA QUINTA, CALIFORNIA 92253
Owner 3ava3 1ZAi38 l iE:l"
'Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
CityZip Tel:
..
:.Contractor
PACifi�a tiade
Address..
No. 14988
0.
City Zip
State Lia -E.42.5381
& Classif
-Arch., Engr.; "
'Designer
Address
City. Zip
ILicy# X955.
Tel.
State
L•ic: # ,
1'�OECLARATION _ ..
ns Chapter 9'(commehcingQ with Section•.
s Code, and•my•Ilcense is irttfull force and
Legal Description
F;roject Description��
.s3.deya drd' .adiid. •j)oal equipment SGtbaC j"
reduction tm'. 3'' :approved_per 5FA '95-3 5
Sq. Ft. 'No.
Size - - - Stories -
New ❑ Add ❑ .. Alter ❑
No. Dw.
Units
Repair ❑
Demolition.'❑
GNAT - - DATE
...
- �..:; ... ..
' OWN EWBUILDER 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 or.county,..which. requires a -
permit to construct;alter,' Improve, demolish, -or repair any structure,- prior to .Its.. issuance also
,requires. the applicariCYoi such permit to file a. signed statement that he Is, licensed. pursuant to
the provisions o/ the Contractor's License Law, Chapter. 9 (commencing. •with Section 7000) o/
' Division 3 of the.Business and Professions Code,- or that. he. is• exempt, therefrom, -,and the, basis
,.. dor, 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 rive hundred dollars ($500). ..
. 0 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, for sale. (Seca 7044, Buisness and
.Professions. Code: ;The Co.,.ctor's License Law 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•bullder will. have. the burden
of.proving.that he.did not build or Improve for the purpose of sale.) .. -
Estimated.Valuation Q �L
s q, 000: .00
.PERMITAMOUNT '
Plari Chk. Dep.- '
'
• • -
Plan Chk. Bal. j .. 20 -
COf1St. ifl� '�Q
•
"' ' ' -
_ Mech. 2 • 00
Electrical -
45 • 00
Plumbing
27 • 00
i{
0'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 contractors) Ucensed pursuant to the Contractor's License Law.) .. -
• O 1 am exempt under Sec. ` B. 8 P.C. for this reason
S.M:I,
Grading
Driveway Enc.
,
Date Owner
Infrastructure
-' Pia nincr
Setb CSC- utaJ iistmen : 1010.00
WORKERS' COMPENSATION DECLARATION .
1 hereby affirm that I have a certificate of consent'to self -insure, or a certificate of
Worker's Com_ pensation Insurance, or a certified Copy thereof: (Sec. 3800, Labor Code.)
PotC3 �N Company '
dopy is filed with the city; 0 Certified copy is hereby furnished.
' CERTIFICATE OF EXEMPTION FROM
' •WORKERS' COMPENSATION INSURANCE
REMARKS
- -
(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 the work for which this permit is issued, I shall not
employ any.pperson in any manner so as to'become subject to the Workers' Compensation
Laws of Califo_rma.:,aT
- -
Date ' A Owner
. , NOTICE TO APPLICANT: ti,•- after making this Certificate •of Exemptbn_.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. ••-Minimum
.ZONE: BY:
Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,'AND
SHALL SUBJECT AN', EMPLOYER. TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
'
Side Street SetbackfrOmCenterLlne
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION T.O.THE COST OF COMPENSATION,-
Side,Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES. =
- li 'is a building p-erim:it w -
This hen properly filled out, signed aril validated; and is subject to
expiration if work thereunder is suspended for 160 days. . .
FINAL.DATE
-
- INSPECTOR
I certify that.I have read this application, and state that the above'informatiomis correct. •
I agree to hereby authorize representatives • this city to comply with all city and county ordinances and'state laws. relating to. building
construction,. and .enter the 'above-.. .
mentioned property for inspection purposes.
Issued -by:
Validated by:
Date Pormit
j 0
Signature of applicant— Date:
Mailing Address
Validation:.
IN
Ad,
By
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW%3 FEES
IST FL. SO. FT. ® $
UNITS
SETBACK
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS 1
CARP. SO. FT.
STORAGE TANK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
ROCK STORAGE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
OTHER APPJEOUIP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
REMARKS:
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
FIREPLACE
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
A HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING ��
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING.
cu. yd.
$ -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 /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
r
GARDEN WALL FINAL
1 f
c
I T4,4t 4 4 QumAv
y -?_q5..
MEMORANDUM
CASE: 41 345 Location(s) : 53 -1 So aW,41>b, c3VArc?_-
Requests) : 3� 5.�� c - .�- WA0,C) -Peel .
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 appro�re1 of the -adjustment. These
circumstances are: -<AA 44.
�
Thank you f¢r�your cooperation.
Attachments
c: Building and Safety Department
CASE NO: 30 S
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.
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PLEASE PRINT OR TYPE
APPLICANT/CONTRACTOR: �-"L J ' DATE
CONTACT PERSON (IF DIFFERENT) -��� �� ��- PHONE
MAILING ADDRESS:
OWNER'S NAME:
MAILING ADDRESS:
(Address) (City)
(State
PHONE I
0
(Zip)
Address) (City) (State) 1(Z
STREET ADDRESS OF PROPERTY:
S
/- C_
LEGAL DESCRIPTION OF PROPERTY:
LOT
#
ASSESSOR'S PARCEL NUMBER: � , 1- Of - C5( -g
ADJUSTMENT REQUESTED:
To
�1-1AA1A-k
REASON FOR REQUEST:
L S�
JUSTIFICATION: No request for a Setback Adjustment shall be grante
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.
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FORM.013/CS
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