3601-115 (RPL)LICENSED CONTRACTOR DECLARATION
Lhereby affirm that I sm,.1.0enied under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my
License is in full force and effect. 574127 .A: 8131/35
License # E Lic. Class X`% ' 6p. Date ,v
(Date � ti SignatureofContractor /, I � _A —
r
OWNER -BUILDER ECLARATION
I hereby :affirm that I am exempt from the Contractor's License. Law for the
following reason:
( ) 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, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
() I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
,(This secti6hfinW'cBA&61) completed if the permit valuatioi< i"s:fo7 $1.00.00 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, and agree that if I should become
subject to the workers' compensation provisions of Section 31700 of the Labor
Code, I shall forthwith comply with those provisions.c .+x* ) .
Warning! Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made &each person at
whose request and for whose benefit work is performed under'or pursuant to
any permit issued as a result of this application agrees to, &shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of wcrk for 180 days .will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned propertyfoinspectio purposes.
Signature (Owner/Agent) "( All [babe
t
ALCM
AU,ILDING
PERMIT
PERM IT1,601."JJ!
DATE a�"b"A°°
VALUATION
LOT TRACT
JOB SITE ADDRESS 47-9,10 VIA NICE,
APN
OWNER
CONTRACTOR
St RVE DODSON C'0NSrRUC'T ON
CWI MURY' ki()M'f�S COii9 NCIN1'1' ES
6880.5A VER V2 RR
1535 soulm D S'ra r #280
C,A`i.TIED.T4.tl.L Ci'[ Y CA 92234
SAN .F3ERN.r RDIN, CA. 92408
(6:19)3.24-12'32 C:RLO tW
(909)38 i -6007
DESIGNERIENGINEER
USE OF PERMIT -1 V t t1 !V ! dJ Illi :1.t d 1
?001: AND SS,?A.
3' REAR YARD S1: �13ACK 1 EDLIC tON APPROVED ,F%M 8:8A -96-s85.
FEE DESCRIPTION
FEES
CGf;I`Ct� AC't A R tCJlJ+�i"C "1 S, (10(1;iiG i. S
.PiIn3,.Y.MA.I A+•�'rD CUST CONSTRUCT
Be600.00
Yls IRMIX FFT SUMMARY
1'{SAN CMCKTIE $105.30
C0%rS'1'.1mcnoNns 101-0004.18-000
WIC11A/ 'ICAL M9 I01 -6t )-421000
T-1XC".I'R.1CAL M' _' 't)OL 101-000-420-000 $45.00
P.I'x'f iWNC3 F.I xC -,Pool., 101-000-41.9-00.0
Si�7ii=1'OTA.l; C;t�7�t5`t"�riC f10Ni ,AN..D 1'.i;. A.N C:HF'G; � .
$363.30
TOTAL POtl`viI FEVS D11%NOW
136330
F
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steil
Combustion.Air
,Raf Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric 4-4 zX
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final r
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
EnSplasulation 3
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
'
q.
�5 78-495 CALLE TAMPICO — LA.. QUINTA, CALIFORNIA .92253 - (619) .777-7000
G;� O
y OF M� FAX (619) 777-7101
.CITY OF LA OUINTA
January 25, 1996 JAN 2 6 RECD
BUILDING AND SAFETY
Mr. Dodson
Dodson Pools
73-011 Country Club Drive
Palm Desert, California 92260
SUBJECT: SETBACK ADJUSTMENT: 96-385
LOCATION:40VANICE. LA QUINTA CA 92253
LEGAL DESCRIPTION: Lb` 417, TRACT 26152
Dear Mr. Dodson:
This letter is to report approval of your recent application for a setback adjustment, pursuant
to Chapter 9.188 of the City of La Quinta Planning & Zoning Regulations. The following
setback adjustment has been,approved subject to conditions and in accordance with attached;
Exhibit A.
SETBACK ADJUSTMENT: lRe^"'du tion from 5' to 3' adiacent to rear prope=lme
E@,R SwimmingtPioolN
-CONDITIONS:
1. Obtain building permit
2. Obtain Lake La Quinta Homeowner Association clearance, if needed.
After review it was determined that:
1. This adjustment is consistent with the intent and purpose of the zoning
ordinance.
�E
MAILING ADDRESS P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
Itrss.346
Id
2. There are special circumstances applicable to the property, including such
factors as size, shape, topography, location or surrounds that justify approved
of the adjustment. These special circumstances are:
small. yard ,
• irregular lot size
3. This adjustment will not be detrimental to the health, safety, and general
welfare of the community or be detrimental to property in the vicinity of the
parcel for which the adjustment is requested.
Should you have any questions regarding this matter, please feel free to contact the
undersigned at 777-7064. `
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
STAN B. SAWA
Principal Planner
SBS:cw
Attachment: Exhibit A
cc: Building and Safety Dept.
City of La Quinta
f
Itrss.346