9606-026 (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
Piofiessi4nals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
571127 A 8r.41 /97
Date S• //% 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,,ssLEed:,My1iwOrkers' compensation insurance cqrrieL,&-tp2licy 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 those provisions.
'Date: Applicant-
Warning:
pplicant 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 3706
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'insppeection purposes.
Signature (Owner/Agent) ( "� Date
Yv r
BUILDING PERMIT PERMIT# CONTROL#
y61111,64112G 3450
DATE 6/ 5/96 VALUATION $11,000.00 LOT TRACT
JOB SITE
ADDRESS 54-64.1; X'KNI DA 11lAKF2
APN
774-262-4119
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RONALD J &RIMA SIKORSK I
"TrEV111 D011SON CONISTPILK-M N,
341115 AVE:NIDA JUAREZ
0&405A P1.'RE:! RD, 6E9
LA QUIN'1'A C'A 92253
CATUIEDRAL r17 Y CA 92234
(c t 324-1 2 C RI.Jf 1444
USE OF PERMIT
i1N ilr.A SPA
K9A. ONLY
/,J�j' / %tf � f C•'� � ' �f` ' ,,- i.. I t!'� � c,. !� i e' ...1 � ! r ! � + � L . � '� � F: i � / -
P{DCA_. A113 OR SP,v I I.iJlJ401) LS
ENTIMATE0 COST OF CONST RUC110N
11.000.00
P ,1?.M1T VXX, SUFAMARY
PLAN0ff_'r7K FEF, SS1.90
FEE 101-000-418-M $126.00
Ad1sCH N(C'AL 1=1;6 -- POOL 101 -OW -1121-000 524400
tsf.is(`'i:MC:ALFF1:•-i'f++�I, It)i-13Ei(3-4119-4'J4 StS,.�}
W.0 M'1NO Fl;t3--,P001;. .' 1101 -NO -419-000 527.00
SUIS•MAL CONSw1XC."1'if3N_ 'AND PLAN CI MCK
$303.90
LESS PRE-PAII) F ES
SOM
TOTALL iPIL'1tf1 IT L+. LON 0111r, NOW
�►30.i �i+ll
JUN 1 x.1996.
ev f
RECEIPT-.=DATE
i
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE I
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Settacks
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel 0414 4,
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric 15
Underground Plbg. Test
Final
PLUMBING APPROVALS
c inal
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
Gas Piping
Gas Test
Appliances
•
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
r �uutuuuVVVu4UUulJuuuuUUVUUyUUuuuuuuVt
f
fREMOVE OR BURY
f EXISTING BOULDER
RAINBOW TABLET
,FEEDER AT EQUSP.
(INLINE)
CAUTION: TV, TELE CABLESTILE
PUMP CAPACITY 60 GPM
MOTORHP'STA DURA HP 1.0
FILTER SYSTEM 3 30Q§Q FT
FILTER RATE 100GPM
TURNOVER '3HRS
RETURN LINES. YES ,
TWO SPR'AYHEADS W/ LN. rE
MAIN DRAIN YES
3410895 P.02
CHECK VALVENOT
HEATER LAARS SIZE NOT BTU
GASLINE BY NOT
GENERAL SPF-CIFICA17ONS
GREAT NN=E AUTO CLNR
CLOCK24 HR 220V
DETAIL FOR CONCRETESIzE
ELECTRICAL BONDING BY: S.D.C.
AND_COPING S.D.C.
11' X 27' AREA 280
CAP ON RAISED BOND BEAM
c
,.
DO NOT SCALL;
DEPTH -3' TO -6'
c
SHAPE CUSTPERIMETER 69'
S " of cantilever
[
TILE SIZE- GROUP 3
r
_
+6" -� /
'
TILE COLOR BUB 22
c
RAISE BEAM 13 ' OF +6 W/TILE
' p�L i
lice face--�—�
i;
b"+
COPINGCArVTILEVER 69'
POOL CAPACITY 9450 GALS
r �uutuuuVVVu4UUulJuuuuUUVUUyUUuuuuuuVt
f
fREMOVE OR BURY
f EXISTING BOULDER
RAINBOW TABLET
,FEEDER AT EQUSP.
(INLINE)
CAUTION: TV, TELE CABLESTILE
PUMP CAPACITY 60 GPM
MOTORHP'STA DURA HP 1.0
FILTER SYSTEM 3 30Q§Q FT
FILTER RATE 100GPM
TURNOVER '3HRS
RETURN LINES. YES ,
TWO SPR'AYHEADS W/ LN. rE
MAIN DRAIN YES
SKIMMER MODEL DUAL, PORT
CHECK VALVENOT
HEATER LAARS SIZE NOT BTU
GASLINE BY NOT
POOL LIGHT 400 W
GREAT NN=E AUTO CLNR
CLOCK24 HR 220V
ELECTRIC BY S.D.C. 101'
ELECTRICAL BONDING BY: S.D.C.
AND_COPING S.D.C.
1 •
P.L.
1
'UND Ess'. CA V A.TI OIN
-CESS THRU GATE
DIG CAREFULLY
POOL LIGHT
SWITCH
. 3
utLr%1NCi BY ,li,C . 250 SOFT
KOOL DECK. x;16 BASE 2(
CONTRACTOR cannot assume
responsibility for damage to
curbs, sidewalks, driveways,
cement slabs, sewers, '
Iawns,trees, fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
understood that you, the owner,
DATE have that neighbors permission
5-31-96 and assume full responsibility.
N=9: aworski
AddrQw: 54645 jaurez
sem: La Quinta, Ca.
Iri: "The Core"
SHOW ROOM polo/Y
73011 COUNTRY CLUB DR.0-4,
PALM DESERT, CA. 92260
PHONE (619) 346-4032
j
27
-3'
Ali %�
nAtk) A -Ir uw/Vr)r)T T1FCi
eristina patio.
TAtT 4.4a Qum&
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
June 10, 1996
Dodson Pools .
73-011 Country Club Drive, #F-4
Palm Desert, CA 92260
SUBJECT: SETBACK ADJUSTMENT 96-417
LOCATION: 54-645 AVENIDA JUAREZ
Dear Dan: ,
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 rear and side yard setbacks from
5 -feet to 3 -feet for a private swimming pool and equipment.
A. 'Obtain a building permit from the Building &. Safety Department, and
B. The pool shall be fenced (minimum five-foot high) -and have self-closing gates.
'After review it was determined that:
L. This adjustment is consistent with the intent and purpose of the Zoning
Ordinance to allow development of single family houses and swimming pools
M an S -R District.
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 in that the private rear yard area is small, and
greater separation is* needed between the house and swimming pool to provide
adequate walking surfaces around the pool for the occupants and/or guests.
sba96.417.
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253
3. This adjustment will not be detrimental to the health, safety, and general
welfare of the community because the rear yard improvements will be
privately maintained and fenced to prohibit access to the improvements unless
by the owner's permission.
If you have any question, please contact me at 619-777-7067.
Very truly yours,
TLOPMENT DIRECTOR
GT.
Attachments
c: KellyTropple, Building & Safe4y Department jjO
I`
CASE NO:
CITY OF LA QUINTA FEE: $100_0.0
PLANNING & DEVELOPMENT DEPARTMENT rle� to I i I GJ%
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. /.:.
PLEASE PRINT OR TYPE J
APPLICANT/CONTRACTOR: IJ G 6_e' C/J ; c) DATE
CONTACT PERSON (IF DIFFERENT) DG V) PHONE 314b -
MAILING ADDRESS: 13 --C// C/CuN r2 V 6/ u/;
(Address) (City) (State) (Zip)
OWNER'S NAME:
MAILING ADDRESS: ? S/��/S ��V • .J��i��2 C.Z, L !�
(Address) (City).,
STREET ADDRESS OF PROPERTY:
PHONE
(State) (Zip)
LEGAL.DESCRIPTION OF PROPERTY:' LOT # TRACT
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED: GJ c7 3 (q�7 Y"(' - ppo 5' 4o
�►� LL�.�) ��1� �C�f'11PiVl�
REASON FOR REQUEST:7/DA/ 4 -
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.
*����*��****�****�*����*���*�**x•****�***********max*****�**x*�*�*****�**�**
FORM.013/CS t'
P.L.
P.L.
C
candle -
tile face -
REMOVE OR
EXISTING B(
UTION:
PC
S1,
I P.L.
HAND EXCAVATION
ACCESS THRU GATE
RAISED BOND
WATERS
BEAM WALL
DGE
OF POOL WITH
O
TILE FACE
QUIP
& TWO SPRAY
R ,
FOUNTAINS
C
T 5'
P.L.
C
candle -
tile face -
REMOVE OR
EXISTING B(
UTION:
PC
S1,
I P.L.
HAND EXCAVATION
ACCESS THRU GATE