15600 (RPL)Building
_Address 14 -664
i71
I ��Owner
fP'$ rklsar`ci
P.O. BOX 1504 No. 15600
78-495 CALLE TAMPICO
arbena LA OUINTA; CALIFORNIA 92253_1
Address same, as above
City Zip Tel.
La Quinta 92253 360a-3976
Contractor
Tim Gilbert, Inc.
Address
39-695 St. Michael Place
Palm -Desert -92211 360-1403
State Lic. - ,City
& Classif. 177233=9 Lic. # 3075
Arch., Engr., -
Designer
Address I 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 rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a)permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (5500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of 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 buil or improve for the purpose or sale.)
❑ 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. contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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: M, after making this Certificate of Exemption you should become
subject to the Workers' Compensa8on provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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 if work thereunder is suspended for 180 days. _-
1 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.
Signature of applicant Date -
Mailing Address w
City, State, ZIp
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description pool . aad Spa
Sq. Ft. No. No. Dw.
Size - Stories Units
New Il Add ❑ Alter ❑ Repair ❑ Demolition ❑'
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Distances:
Plan Chk. Bal.
76-0 5
Const.
117.00
Mech.
24.00
Electrical
41; 0
Plumbing
27,00
S.M.I.
Issued by: -
Grading
Validated
Driveway Enc.
by:
Infrastructure
Validation:
TOTAL
REMARKS
ZONE:
. BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Re� r Prop. Line
Side Street Setbackffrom Center Line
fromoProperty Li-ne
Side Setback
'
FINAL DATE
INSPECTOR
Date �li)
Issued by: -
. • Permit`'
Validated
�\ > cy -49r-)
by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM r
STORAGE TANK
MOBILE HOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WI*ING
DUCT WORK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
SERVICE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
BOND BEAM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
1�}\
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GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. 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
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M ECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL ^ f HEATING & AIR COND. SOLAR
1i 4
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPT
—A K
ROUGH WI*ING
DUCT WORK
ROCK STORAGE '
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURE'SlINITIALS
GARDEN WALL FINAL
� r i
A90
I
.100,01000,
�t
�pz
/o xro'
FA P
y+9 9
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
DATE AZ41Y � BY e4►'
I
6ARAG CC
RIA
J
A
wl
SCALE: APP OVE )BY: DRAWN BY�
_ II s
�/
DATE: �S 3 9 / /
.- � � � REVISED
GO
TiAt 4 4Q�rw
MEMORANDUM
CASE: Location(s): �{4 -ivy Ve-,`v�o_ C1�C c Fla,f,2>
Request(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:
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
circumsta are:
Than u f r your cooperation.
Since lv.
Att
.c: Building and Safety Department
J
CASE NO: S— 3. -3-
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 property, a letter must be
submitted by the owner authorizing the Applicant to execute this document
in his behalf.
PLEASE PRINT OR TYPE
APPLICANT/ CONTRACTOR: r /,,��i'ly` DATE
CONTACT PERSON ( IF DIFFERENT) PHONE
MAILING ADDRESS: >.�� i` . !/ iZ-• 07
(Address) (City) (State. (Zip)
OWNER'S NAME: -; c, C'� {z C7%�! �('�PHONE • ,7,.6O 3�r �7 C�
MAILING ADDRESS: Ams Lb t -!/U 4 /«�(�lMI 1'.1
(Addr� ) (City)(State) (Zip)
STREET ADDRESS OF PROPERTY:
LEGAL DESCRIPTION OF PROPERTY: LOT # TRACT
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED:
REASON FOR REQUEST:
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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