15649 (RPL)TAtvl 4
fp P.O. BOX 1504.. No.- 15649
Buildingr 78-495 CALLE TAMPICO
Address '" g -j �'� � �� k �� LA QUINTA, CALIFORNIA 92253
Owner Paul Rowe '
Mailing
Address SaMe
CityZip ' Tel.
La iota, CA 9223 56-2697
Contractor
owner/Builder Subsist attached
ty lZip I Tel.'
State Lic.I City
& Classif.. Lic. #
eucn., r=nyr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
Thereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70D0) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness 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 applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with -Section 7000) of
,. • Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for ;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).
" E] -I` Its 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, Buisness and
_ Professions Code: The Contractor's. License Law does not apply to an owner or 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 -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
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 propertywho-builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuannto the Contractor's License Law.)
❑ I am exempt under Sec B,& P.Corthis reason
ate - " t •e ^ 6)1 Owner X J .cam *� •% /
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
O Copy is filed with the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(Thissectionneed not be comp%eted it the perma�.�for one hundred dollars ($100) valuation
I certify that in the performance of ht ep work for ieh this permit is issued, I shall not .
employ any person in any, manner so as to becyQfmgesubject to the Workers' Compensation
Laws of California. +
j Date's 'OL Owner - ` r
OTICE TO APPLICANT: 'l/,^akar making this Certificate of. Exemption 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.
i
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
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,
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
expiration it work thereunder is suspended for 180 days. .
I certify that I have read this application and state that the above information is correct.`
1 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.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST.,- OCC: GRP.
A.P. Number
Legal Description
Project Description Pool
Sq. Ft. No. No. Dw. -
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
s
i
stimated Valuation 8 x'000 . 00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.64-.35,
Const.
99. GO' .
Mech.
24.00 .
Electrical
e— 45.00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
G59.35
REMARKS,
ZONE: BY:
Minimum Setback Distances:
Front Setb dk/f^ Center Line
Rear Setbackd • m Rear Rrrop. Line
Side Ste t� et )ack r�Fenter Line
SideSetback f600m Propery Line '
FINAL DATE y�L INSPECTOR
Issued by: D e �%zO.Per iflt / r
Validated by:
Validation: /
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
A.C. UNIT
COLL. AREA
,
1ST FL. SO. FT. ® $
UNITS
HEATING (ROUGH)
STORAGE TANK
FORMS
YARD SPKLR SYSTEM i
2N0 FL. SO. FT. p
DUCT WORK
�
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
OTHER APPJEOUIP.
REINF. STEEL
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. SO. FT.
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
FINAL INSP.
DRINKING FOUNTAIN.
SO. FT. ®
_$
URINAL
ESTIMATED CONSTRUCTION VALUATION $
ROOFING
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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
INSULATION/SOUND
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
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 d�
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
FINAL INSP.
.3
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
ROOFING
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC. /
FENCE FINAL
INSPECTOR'S SIGNATUIESIINITIALS
GARDEN WALL FINAL
ryr��
5D
i
4
5D
i
13
CITY OF LA QUI
NTA
BUILDING &SAFETY DEPARTMENT
CONDITIONALLY
A -�rm Fo
CCEP t: q CONSTRUC-Ir-PON
SUBJECT TO INS T.AblATICAN AS P&,
AND ALL APPLICABLE CODES -
DATE By
MEMORANDUM
CASE: Location/9S_
Request( ) e
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: ./ a.,J w/ en
�--
/6-0
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
circumstances are:,9,�
Thank youf your cooperation.
Sin4rely,
n
Attachments
L
c: Building and Safety Department