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
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