15015 (PAT)t�.
lj
Building
Address
Owner
P.O. BOX 1504
78-495 CALLE TAMPICO
48-555. Via—Amistad LA QUINTA, CALIFORNIA 92253
Bryan Wiiiick
Address Same
City
La .Q1ainta, CA
Zip
. 92253
Tel.
1 564-2803
Contractor .
Owner ,Btaaider:..
Address .
City `
Zip
Tel.:
State Lic.
& Classif..
City
Lic. #
Arch., Engr:,
- Designer '
Address
Tel.
No. 15015:
11LDING: TYPE CONST. OCC: GRP.
P. Number
Igal Description
oject Description Pat'3® CoVer
Sq. Ft. 175 No. No. Dw.
Size Stories • Units
New 0 Add ❑ Alter ❑ Repair -E] Demolition ❑
Date- /740-7.% Owner r
City
Zip
State
Lic. #
subject to the Workers' Compensation. provisions of the Code,' you mush forthwith
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: - -
Disfarices:
ply with such provisions or this permit shall be deemed revoked.
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,Businass 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 thatthe 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 (5500). • •,
E1„ 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. n, 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 town 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.)
❑ I am exempt under Sec. B. & P.C. for this reason
g
Estimated Valuation
2 132 2.00
I
PERMIT -
- AMOUNT `
- -
Plan Chk. Dep. ... -
-
Plan Chk. Bal.
d •�
COr1St.
54.00
Mech.
Electricals
'
Plumbing
-
S.M.I.-
-
- .23
Grading
-
Driveway Enc.
Owner --a"=-
Infrastructure
ATTORNEY'S FEES.
FINAL DATE
INSPECTOR
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 Woikers' Compensation
Laws of Ii I forn!v - s
This is a building peimit when properly filled out, signed and validated, and is subject to
expiration If work thereunder is suspended for 180 days. .
TOTAL
89.33
REMARKS
Issued by: `
Date
1 agree to comply with all city and county ordinances andstate laws relating' to building
'representatives
Date- /740-7.% Owner r
NOTIC TO`APPLICANT: II,�aHer making this -Certificate o! Exemption you.shoukl become '.•
of,
ZONE: -
BY: -
subject to the Workers' Compensation. provisions of the Code,' you mush forthwith
Minimum Setback
Disfarices:
ply with such provisions or this permit shall be deemed revoked.
-
'
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE 'WORKERS'COMPENSATIONCOVERAGE IS.UNLAWFUL,AND
Side Street Setback from Center Line
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,
Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF -THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
INSPECTOR
This is a building peimit when properly filled out, signed and validated, and is subject to
expiration If work thereunder is suspended for 180 days. .
I certify that 1 have read this application and state that the above inforrnation'is correct.
Issued by: `
Date
1 agree to comply with all city and county ordinances andstate laws relating' to building
'representatives
construction, and hereby authorize of this city to enter the','above=.
mentioned property for inspection purposes.
Validated by:
Signature of applicant. Date
Mailing,Address
Validation:
City, State, Zip
n I a
v
By . I .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER OR SEPTIC TANK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. ®
HEATING (FINAL)
OTHER APP.IEOUIP. '
WALL S0. FT.
DRINKING FOUNTAIN.
$0. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
FIREPLACE
S0: FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
MESH
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.G. 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.IEOUIP. '
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus 'X$-=$-
x$=$ROOFING
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 SIGNATURESIINITIALS
GARDEN WALL FINAL
:.LAGUNA
ARCHITECTURAL VARIANCE REQUEST
Unit #Date H (�
Street Address �U ���5 �11A elm —rA0 J
Local Phone �6 Lf 12 SIC) Other Phone
To the Architectural Committee:
We, the undersigned owners, 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 Quinta and that the cost of the
permits and responsibility of obtain.ing permit"s and
subsequent inspections will be borne by us.
We ackowl-edge that 'all appr,oved changes in the original
design will be at our expense; that any d,amage to or
relocation of. existing sprinkler systems, underground
utilities., building structure and exterior landscaping or
other damage resulting from construction of these permitted
improvements will be at our expense; and that maintenance of
the permitted improvements will be at our expense.
Signature of all owners:
Y
Please provide as much detail as possible so that the
Committee may consider approval without delay!
.4T �,gZS res r�
-Do Lc5-Ft e,
t
The above proposal has been reviewed by the Architectural
Committee and has been:
-'APPROVED REJECTED! PENDING FURTHER O
O INFORMATION
Comments:
11;9 DATE: "!
Committee Committee Committee
Members Member Member
MEM0RAND U.M
CASE: - 30(o Location (a) s. '+g - 555 �► ����5�-��
Request (s) : ' Kms, rL ZVN c� o /N
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:
40
1
After.review it was determined that: .
..1. This adjustment•is consistent with the intent and purpose of
the Zoning Ordinance.-
-2.'
rdinance._-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:
-Thank you for your cooperation.
Si
Attachments
c: Building and Safety Department
ASE NO: 119 30 (a
CITY. OF LAUINTA FEE: $100.00
PLANNING & DEVELOPM
rn
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:
CONTACT PERSON (IF DIFFERENT)
DATE /36-,e. 9 <
PHONE —S-6 y- ;Z fir -03
MAILING ADDRESS: �� - S� �� VIA S7-, �� CA
(Address) (City) (State) (Zit)
OWNER'S* NAME: & yA-r\J (,J l L L c—fC PHONE
MAILING ADDRESS:�L
(Address) (City) (State) (Zip),
STREET ADDRESS OF PROPERTY: �4n c -
LEGAL DESCRIPTION OF PROPERTY: LOT #-
ASSESSOR'S PARCEL NUMBER:
TRACT
ADJUSTMENT REQUESTED: '6, S� ,e-eA-2
REASON FOR REQUEST:
//.4 k
L�eusz ig- S,77W4&� oti Wog -T -H PL, reiLL(dt CWu, ��sc�cf a,�, QJSinO of klX4SC
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 theadjustment'is requested.
FORM.013/CS
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Amle
- Ascher
�' •`�'� Provide 1"
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NOT-prrMlws••
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mam lNUWM f,C=D& lobed Anchors Y da exec.
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Ibmfirq Note
s• Wad shakes 6/12 pitch 13/12 nig. pitch t.=th 301
felt underlay) Class A
D. Wed. co Positier. s`_•Kles 4,112 pitch (3/12 mi..
Pitch with 150 felt trt8W lay) - Class A
c. Walt up rolled roof slue to dra_..
d• 1bck roe` 3/12 2ax:--4.n pitch.
I
TRIM PATiG = R
dmg1" tis
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OW
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fid
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600 10
('►
Ibmfirq Note
s• Wad shakes 6/12 pitch 13/12 nig. pitch t.=th 301
felt underlay) Class A
D. Wed. co Positier. s`_•Kles 4,112 pitch (3/12 mi..
Pitch with 150 felt trt8W lay) - Class A
c. Walt up rolled roof slue to dra_..
d• 1bck roe` 3/12 2ax:--4.n pitch.
I
TRIM PATiG = R
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