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12615 (PAT)t,. 6 414 0 1 P.O. BOX 1504 No. Building 78-105 48-556 Via Ai4 stad LA QUINTACCALIFORNIAALLE 92253 DO Address , Owner Mr. 'Richard Dahl Mailing Address 48-,556 Via 1mstad City Zip Tel. .. ..,....,�.. vim.. ....... ractor Aaares061-263 Palo Verde City Indio zi'b12201 State Lic. & Classif. 541464" Arch., Engr., Designer Address Tel.' 347-8521 City Lic. # 3837 Tel. City(Zip ( State Lic. # LICENSED CONTRACTOR'S DECLARATION 1 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) or 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). O 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 build or improve 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 property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 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. 0 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 the 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. 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.) Lender's Name 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. Signature of applicant Date Mailing Address City, State, Zip 12515 BUILDING: TYPE CONST. OCC: GRP." r A.P. Number Legal Description Project Description Patio Cover Sq. Ft. Size New W No. Stories No. Dw. Units Demolition ❑ Add ❑ Alter ❑ Repair ❑ Estimated Valuation $3,26 1.9Q PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal.{ Const. Mech. Electrical Plumbing .S.M.I. Grading Driveway Enc. Infrastructure' TOTAL I IRA_49s _ 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: Validated Validation CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SO. FT. FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING ' CAR P. SQ. FT. ® FINAL INSP. WALL SQ. FT. WATER SYSTEM DRINKING FOUNTAIN. GRADING cu. yd. $ -Plus-x$-=$ URINAL SQ FT ® FINAL INSP. FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRYTRAY AIR HANDLING UNIT CFM IKITCHEN 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. 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 rffFINAL INSPECTION 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 APP./EQUIP. 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 rffFINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 68-895 Perez Road Suite 23 Cathedra) City, CA 92234 (619) 324-581.1 FAX (619) 324.1701 LAGUNA DE LA PAZ ARCHITECTURAL VARIANCE AUTHORIZATION . t , NAME MR. RICHARD DAHL ADDRESS 4& 55_6;�VZAYAMISTAD_;t'A ` Your request for Architectural Variance has been,approved by the Architectural Committee— Any -changes requiring a .Building permit must be obtained through the City and must pass any City inspection. All changes must comply with City and County Codes. ~� SPECIAL NOTES Owner to obtain Variance to re.ar setback if required by City of La Quinta. i ' S - Thank ou, Na c D e Account Executive REGIONAL OFFICES imine . Rancho Cucamonga • San Clemente • SouU+ Bay • Coachella VWW • San Drego S .�_ LAGUNA ARCHITECTURAL VARIANCE REQUEST Unit ♦' Date Street Address _5 ro Local Phone /- �% other Phone To the AreritaatuTsl COmmittee: we, the underligned ornar:, request your approvet of tha modifications proposed en the reverse side Of this form. Attached are drawings of the rock to be d*nai. tYpa$ 0 motorial to Be used are indicated an the drawings. wa understand that building permits for ,home improvemantl ora sepuired by the City of La Quints and that the Coit of the permits and responsibility of Obtaining parmita and subsequent inspections will be borne by'us. we ackow1*09e that all approved changes in the original �d*aign will ba at our expense; that any damage to of ' :d!raloCation of existing aprlhk#er systOM0, undgrpround utilities, building atrUCture and exterior landacaping or —_ "other damage resulting from construction of these permitted Impravements will be at our expense; and that maihtenanus of —the Permitted improvements will be at our e'4Penae: Signature of all ow,nerst �r ►S� 4u pry . • 0.0714 .YOU � hod i P� 5' • ! / / ,� �� o�vc..�, C rY of — t%Yi lv'r L1071L. rf�r'- ,q,�Cn��i��'� f _ Plaasa pevvida b! much gateil as po•siDle so ChI't the Committee Tey consider approvalwithout deleyt �/f O RC1 G[� /,C L %�/¢,rN r `��,E W i The above proposal has baen reviewed by thi ArChitOttura: CamTittas and las boons r APPROVED RE�rCTEa 0a�rosHo- rUItTRE4 iMPGANa710N 0, Csmeente� •(� � _ � • 00 aAT�: �,,� C% Committee Coo i:ao eomm4t:ee M ae ,4 a;* mba! r Ol/ I � - D � SLOPE lye F7r F— .now. I� j' I p � Ccn t> 70 !cb 1p, to 9j .now. I� j' I p � Ccn t> 70 I� p � Ccn t> 70 p � D t> 70 to 9j I 0 > -