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15044 (PAT)44 P.O. BOX 1504 N o . 15044 Building 40-503 Via ,m$stad 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA.92253 Owner Rcbert Fernald Mailing' BUILDING: TYPE CONST. OCC: GRP. Address Same A.P. Number City Zip Tel.. .La quinta, CA 92253 564-7904 Legal Description v`i.`� �on construction A ces Spalding Dr. Kermuda Dunes; -CA :2201 345--54' 2. State Lic:43656 City CClassif. Lic. # Arch., Engr., ' Designer. Address Tel. City ( Zip ( State Lic. # LICENSED CONTRACTOR'S. DECLARATION I hereby affirm that I'am-licensed under provisions"ofaChapter•9,(commencing with Section 000) of Divisiofi 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 per 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 t3.y' 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). O 1,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 build or knprove for the purpose of 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 propertywhobuilds or improves thereon, and who contracts for such projects with a contractors) Iicensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. 8 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 npensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy 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 N the permit is for one hundred dollars (5100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any pparson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: N, 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. 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 3708 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. I certify that I have read this application and state that the above information is correct. I agreeto 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 t Date Mailing. Address City, State, Zip Project Description Patio Cover ..Reduction of rearyard setback to 5 approved per SEA 95-308 Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair -0 Demolition ❑ Estimated Valuation. 0 .$4,775.00 PERMIIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. b •MCI Const. 72. 0 Mech. Electrical Plumbing S.M.I. .45 Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line , Side Setback from Property Line FINAL DATE INSPECTOR Issued by: ' Date Perm Validated by: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIIQ FEES 1ST FL. SO. FT. @ $ UNITS SLAB GRADE 2 ND FL. SO. FT. @ BONDING YARD SPKLR SYSTEM t + POR. SO. FT. @ MOBILEHOME SVC. BAR SINK GAR: SO. FT. @ POWER OUTLET ROOF DRAINS CAR P. SO. FT. ® GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO. FT. @ TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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 GAR. FIREWALL SO.FT.GAR @ 3/ac HOUSE SEWER LATHING 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 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 GRADING cu. yd. $ plus x$ • _$ LUMBER GR. FINAL INSP. FRAMING �' 11 FINAL INSP. ROOFING I REMARKS: VENTILATION 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 aley .MEMORANDUM 5B A CASE: Locations) 503 VNI Requests) �} � << �c.a.,r `1W M9 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 prov.isions'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 circumstances are: re,,),r �4,grtc�. Thank you for your cooperation.. Si `erely • � ,.v i `f !� S C u it Development Department Attachments c: Building and Safety Department CASE NO: 9JE__ 3 08 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 f, fSOn rvn s f cu' L i o o DATE 1'71'7 '7 `S— CONTACT PERSON ( IF DIFFERENT )� ;� 1 ;7 ��y h� s G y, PHON��l9Z �S-�� 7Z MAILING ADDRESS: (Addr'ess �er� City s CA S" Z 2 D / tate) T Zip OWNER'S NAME: �,� r� fi ern 2 l PHONE//f��-79D� MAILING ADDRESS: ?'G�' Sly �l 1yji��2�/ �� i n12 CA f-2 2 (Address) (City) (State) (Zip) STREET ADDRESS OF PROPERTY: T LEGAL DESCRIPTION OF PROPERTY: LOT # © _� 2 TRACT 2 p©5 Z ASSESSOR'S PARCEL NUMBER:_ ADJUSTMENT REQUESTED: REASON FOR REQUEST: JUSTIFICATION: No request for a Setback Adjustment shall be granted unless it 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 00, olws p -ZDA gA 37 -L-LV-1 N3-�O Nl -24� nnw,, •k) rq 1-1:;oG 17- . .. . ......... 8b1! '(- 1 Please Comm.ittee'may przvide as much consider detail as possible so that the approval without.delayl, S .S e � �b ti -r �. ©1� r -h-r a � ��v -Gv ✓. e r � � s The above proposal has been reviewed by. the Architectural Committee,and has been: APPROVED E:. ECT -0O PENDING FURTHER INFORMATION O Comments: DATE: i X&2 i LAGUNA_ 1) E 1- A 1' A /- ARCHITECTURAL VARIANCE REQUEST # Unit �aJ,2 ' 3 (� 3,3 — i Date Street Address, IL8- 5D,3 Vi A Sta Local Phone6/� ~��- X90 ' Othes Phone To the Architectural Committee: We, the undersigned owners , -request ,•request your approval of the modifications proposed on the reverse side of this form. Attached are drawings of the work to be done; types of material to be used are indicated on the drawings. we understand that building permits for home improvements are ' required by the City Of La Quina \y and thetl the cost of ;he permits and responsibility of'obtaining permits and subsequent IIns.pections -will b.e'btorne\by,--'us. we ackowledoe that all approved changes In '.the original design will be at our expense; -that any damage to or relocation orf exist'ing sprinkler*systems., 6n.de•rground . utilities,. building �s1ruc.ture',and exteri�or�lendscaping or ' other damage' r`e'sulting from' construction of .these permitted improvements will 'be at our expense; and �that "maintenance of the permitted imp'r'ov,ements fwill, be `'at our .ex'pense. Signature ' f r F_.... _.. ` /� f � _^� .�•s ���a--,ry�M'' , o all owners:,,,, s Please pr3vide as much detail as possible so that the Committee may consider approval without delay! fpr ?17 r G v ✓ e r V� a A0-7� The above proposal has been reviewed by the Architectural Committee and has been: APPROVED EZECT_O O PENDING FURTHER INFORMATION O Comments: I DATE: