12828 (RPL)P.O. BOX 1504 No. 12828
Building 78-975 Skyward Way 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Auther Weisssbein
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address Same A.P. Number
City Zip Tel.
La; Quintal C ,1 92.2.53 1 Legal Description
ContractorPoo and $
Project Description 3 �''
Western Pools
Address
43-375 Madis6n Street
Cithid.4or CA
T ip 92201
Tel. 347-5959
State Lic.
City
& Classif. C53 348768
Lic. # 1151
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition3 ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under 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 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 applicant for such permit to file 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 five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation
$15,375.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. BBI.
11 j
Const.
171, U
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 of property who
Mech.
24, 00
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
Electrical
4 0:
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.)
Plumbing
27.00
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. 8. 8 P.C. for this reason
S.M.I.
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.
TOTAL
378.15
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 thg 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.
Date Owner
NOTICE TO APPLICANT: If, after 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.
ZONE: BY:
Minimum Setback Distances:
'
Front Setback from Center Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the.
work for which this permit is issued. (Sec. 3097, Civil Code.)
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
Lender's. Name
FINAL DATE
�' 1
INSPECTOR '
Lender's =Address
This is'a building permit when properly filled out, signed and validated, and is subject to
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.
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.
Issued by:
3
Validated by:
Date mit
If
Signature of applicant Date
� 117
Mailing Address
Validation:
t x994
a
City, State, Zip
["By
CONSTRUCTION ESTIMATE
NO. . • ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®'
FINAL INSP.
DRINKING FOUNTAIN.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
1AMPERES SERV ENT
SHOWER
BOILER - B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
A.C. UNIT .
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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 SIGNATUREWINITIALS
GARDEN WALL FINAL 71
Starlight Dunes homeowners Association
Architectural/Landscape variance Vequest
Homeowner flame: �yQ �. G /5 S 6 r, N Date:41�
Property Address: 72 9 7 4 _moi ,Ilz/A A rI btl o
T '
Local Phone Number: o / 8 Z Other Phone (lumber:
Mailing Address:
v
Variance Requested: _S� i (f,-- �'✓ ��U %� -y X 2 ��L
ARIAk e,
essy0q/ _ v
Approval is requested for the above variance in accordance with the plans attached. We have attached
two (2) sets of plans detailing the work to be done and a complete description of the materials to be
used.
We understand that building permits for home Improvements are required by the City of La Quinta,
and the cost of the permits, the responsibility for obtaining the permits, and subsequent inspections,
will be paid for by us, the owners.
We also understand that we will be responsible for the costs of this variance, and any and all damage
which may occur to the common area property, including, but not limited to, sprinkler systems,
utilities, buildings, lawns, plants, trees and existing drainage areas, will be corrected at our expense.
We understand there is a refundable damage deposit of $ required.
We agree that the variance will be completed within days. We further agree that ,if any
damage, as stated above, or failure to complete this variance, is not corrected or finished by us within
this time frame, that the cost for completing this work will be deducted from the deposit held by the
Homeowners Association, and any such work will be comp) ted by the Homeowners Association.
Signature of Homeowner(s)
O'his request may be submitted either to the Management Co. or any Architectural Review Committee Member)
Approved: dejected: Pending Further information:
Comments:
Approved by:
t
p
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA,. CALIFORNIA 92253