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15265 (RPL).: *. s.44j P.O. BOX 1504 No. 15265 Building78-495 CALLE TAMPICO . _Address 51 095 five. Herrera LA QUINTA, CALIFORNIA 92253 .. Owner 8t*duie' l CC ronel MailnBUILDING: TYPE CONST. OCC: GRP. _ 'i g P. SS , - Box 12-3 � CILa Q�1nt�y IZIP 92253 Contractor C�gnzi2l Ca��t�ac `4�•, Addre�`s" . &a.E7. BOX .12.3.$. 1a Quiptto D G State Lia & Classif... Arch., Engr.; 'De'signer A.P. Number Tel. ( Legal Description Project Description ?C?43 Side :yarn:. seltha,d - xedtced to .3' approved . . per SBA 95-.330: `'cam e-1, 92.253 (619) 564-4604 City 2261• Lic. # Sq. Ft. Size . New ❑ No: No. Dw ��Stories- • Units Add ❑ Alter p Repair ❑ Address ..t el. City Zip State L-ic. # LICENSED CONTRACTOR'S DECLARATION ' I hereby affirm. that I am licensed Ainder provisions'of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and -my license is in full force and .•effect. SIGNATURE . DATE : OWNER -BUILDER DECLARATION I herebyaffirm that I am exempt from the Contractor's License Law.for the followingc Estimated ValUatlOn reason:. (Sec. •7031; 5, Business and Professions Code: Any, city' or ,county which requires. a - .- permit to.construct, efter,'.Improve; demolish, or repair any structure, prior to Its issuance also. - t requires. the applicant for•such-permit to file a signed statement that he is licensed *pursuant to: PERMIT - *• the provisions of the'ContractoPs License Law, Chapter 9 (commencing with Section 7000) of .• - -" Division 3 of. the Business and Protessions Code, or that, he is exempt theiefrorn,'' and :the basis . for the alleged -exemption.; Any -violation of Section 7031.5 -by :any applicant 'for d' permit. - Plan Chk:• Dep." subjects the applicant to a civil penalty of not more than five hundred dollars (8500).. - Plan Chk. Bal. O I, as owner of the propeity, or my employees with wages as their sole compensation, will TOTAL do the work, and the.structure isnot intended or offered for sale. (Sec. 7044, Buisness and t 'Pro/esslons. Coder The'Cbntractor's License Law does not apply to an owner of property who builds,oi improves thereon and who does such. work himself or through .his own employees;Mech provided that. such Improvements. are not Intended or offered.for sale. If, however, the building . or Improvement is sold within one year of completion, they owner.builderwill have the burden of proving that he: dM not build or improve for the purpose of sale.) .. O'I, as owner of the:property, am exclusively contracting with licensed contractors to:ccn- 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.•'S.M.I. such projects with'a contractor(s) Ucensed pursuant to the Contractor's License Law.) - ❑ :l am exempt under Sec B. & P.C. for this reason CDnst. _ . - Electrical Plumbing Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I' have a certificate of consent to self -insure, 'or a certificate of Worker's Compensation insurance, or a certified copy thereof..(Sec. 3800, Labor Code.) Policy No: Company ❑ Copy is filed with the city. ❑.Certified copy is hereby furnished:, " WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND ' employ any pperson in -any manner so as to become subject to the Workers' Compensation laws of Cal ifone.' Side Street Setback from Center"Line ' e . TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS. - BY:'- t "' - WORKERS' COMPENSATION INSURANCE • - ' Minimum Setback Distances; . - (This section need not be. completed if the permit Is for one hundred 'dollars (S.100) valuation Front Setback from Center Line ' or less.) - " " -- -- I certify that in the performance of the work for which -this permit is issued, I shall not Rear Setback from Rear Prop. Line " WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND ' employ any pperson in -any manner so as to become subject to the Workers' Compensation laws of Cal ifone.' Side Street Setback from Center"Line ' e . - Date Owner t . NOTICE TO APPLICANT:_ ff,, alter making this Certificate of Exemption you, should become ' ZONE: - BY:'- t "' subject td the Workers' Compensation provisions of rthe Labor Code, you must forthwith' ' comply with such provisions or this permit shall be deemed revoked. - - • - ' Minimum Setback Distances; . - Front Setback from Center Line Rear Setback from Rear Prop. Line " WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Center"Line 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, Side Setback from Property Line . DAMAGES AS PROVIDED FOR IN SECTION' 3706'OF THE LABOR `CODE, INTEREST, AND. ATTORNEY'S FEES. - This is a building permit when properly filled out, signed and validated,•and is subject to FINAL DATE INSPECTOR expiration if work thereunder is suspended for 180 days. I certify that I have read. this application and'state that the above information is ,correct. - Issued by: Date Permit 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. Validated by: Signature of applicant Date ,Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SO. FT. BONDING YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GA`R. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. GAS (ROUGH) DRAINAGE PIPING 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 properly tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER i FINAL INSP.. - 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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO: FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c HOUSE SEWER MESH 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 PLUMBING.? / UNDERGROUND /3 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 1f GRADING cu. yd. $ plus x$ =$ LUMBER GR. i FINAL INSP.. - FRAMING FINAL INSP. ROOFING VENTILATION REMARKS: FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL MEMORANDUM CASE: �15�= 3 3D Location(s) : 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: •l. 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:; Thank you for your dooperation. Sincerely., Attachments c:Building,and Safety Department CASE NO: 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 propertl submitted by the owner authorizing the Applicant to'; in his behalf. PLEASE PRINT OR TYPE APPLICANT/ CONTRACTOR: i� �n•Q V-vC�,l _ CONTACT PERSON (IF DIFFERENT) MAILING ADDRESS: OWNER'S NAME: MAILING ADDRESS: s (Ci L. -,I- Lvf C-� be iq DATE `Q j —c-1 PHONE 6L' — 4 b O I - (-A- - `7 Z 2,5 5 State) (zip) PHONE STREET ADDRESS OF PROPERTY: DGj%j LJ -C- ,v LEGAL DESCRIPTION OF PROPERTY: LOT # ASSESSOR'S PARCEL NUMBER: ADJUSTMENT REQUESTED: TRACT. REASON FOR REQUEST: n 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 ®*4 700L. 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