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9511-131 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed 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. License # ' Lic as ('y'Exp. Date Date it, Vic, Signatureof Contractor a// OWNER -BUILDER DECLARATION 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). O 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 insuranbe, 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 section need not be completed if the permit valuation is for $100.00 or less). () I certify that in the performance of the work for which this permit is issued, 1 shall nop%y Vvf 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 3700 of the Labor Code, I shall forthwith comply with those pr visions. Dater .; rI.-.4!j Applicant 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, -Pr 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 work 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 A01T.-mentioned property for inspection purposes. Signature (Owner/Agek) Date ALC "BUILDING PERMIT PERMITS.511 I;I DATE VALUATION $112,499.7! LOT TRACT JOB SITE ADDRESS APN S 260 AVENIDA VILLA 771-7474.-004 OWNER CONTRACTOR Y V 0,,' N POOLS 1? fl9r..T�1n t� !'17 0• P" I ft Cr}"{y 1i:0.Vlf.t"11'atJ YY �.:�r. 1:eyA tit .1 ,[Tt'�,i... i.�. `1'TS A'F A j�jC Q'Y' -^.'.J.J I.J 1i71:iYL1 ItU�'1 LJA 32,260'AMi IDA VILLA 1ND10 CA. 92202 J,A Q'GJIN'TA CA 9.22.53 (7: L31. 1151 DESIGNERIENGINEER USEOF,PERMI,)WL ANIVOR. SPA PO(X, ONLY -1410 HEATER EXIST INO 3' 11iGH WALL TO B 13.�i..01ASHED AND KEPLACIM ION WITH 74' OF S' IfiJGH GARDEN BLOCK WALL. 'Y FRONT ?fA1+D SETBACK REDUCTION Oyl:,IJ K VA` XC -- DESCRIPTION FEES POOL AMOR, SPA, 10;$7c.ttE1 LS S F`1'. WALL 75.00 Li: 1'�$YMAI Efli COVC OF CONI S -11"'R tCRON IZ 499.75 VERMITFEL SUMMARY PLAN C14RCK Fly 101-000439.3..19 3f3t.S�5 CONSTRUMIOiv F 1.OI-fat)-�t11i-p0U $1 sd.1i0. MIX.'14AN1CAL V8S -- :PO()L' 101 rO -421,-000 ELECTRICAL FEE -- €'OUL 101-000420-W0 194510 � 'i',L:Ux' BINTOFEE�-PCSL 101000.419-000 3217,00 rn C� D7 SUS,TOTAL CONS RUCTION AND PLAN CHECK 032..90 LESS `1 RE-.PA.ID FEES $0.00 awr% 1.a.... a✓ M,>.:aaWt Y.. a _S in as ur.i [.a..Nv F, !`C3"!'A•[: >)';<dC%i. aC"t :P 11CI1 �1'` ': 1hS 321." 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 Steel Combustion Air Roof 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 _:�jI Final Final I I BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond BeamApproval to Cover Equipment Location Underground Electric Underground Plbg. Test 5— Final Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Q 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: ceit,, aha w MEMORANDUM 1/— 2 7 - 9S� CASES- 3(P Locations) : 5 ��a �Eji q 4 V1 Request (9) : ed4,� s,A2P ,.,� o -►c1 AcLs� aN, � -�� � o / a -.•-tee .foo l � q �,c., 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 appr Val of the adjustment. These circumstances are: Thank u fo our cooperation. Sin ly, c6lidu ity. velopment Depar ent Att hments CITY OF LA QUINTA PLANNING & DEVELOPMENT DEPARTMENT ,APPLICATION FOR SETBACK ADJUSTMENT CASE NO: FEE: $100.00 APPLICANT: Submit this form with two copies of a scared 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. APPLICANT%CONTRACTOR: PLEASE PRINT OR TYPE IA 12 Sfie r h • PDO 15 CONTACT PERSON (IF DIFFERENT) MAILING ADDRESS: q3 - 2 75 mei d I50h St. 10,4101 (Address) (City) DATE; IVO V 20 9!5- PHONE SPHONE 3 y7 s9 S9 C/4. y Z ZO State) (Zip) OWNER' S NAME: R i G� a Mrd S rta Ke r- PHONE MAILING ADDRESS: (Address) (City) (State) (Zip) STREET_ ADDRESS OF PROPERTY: ,SZ -2-60 'AVe Vl, LEGAL DESCRIPTION OF PROPERTY: LOT # TRACT ASSESSOR'S PARCEL NUMBER: j ADJUSTMENT REQUESTED: 3 S eT �A c k o r s t w pct-Ojz Q REASON FOR a.arXvuua . -, , N.— y y yy.y yy y y y .yh yy y yy yy y y yy 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 t.o 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 adjustmen_ is requested.' FORM.013/CS el�.. western �o.ols CUSTOM POOL/SPA BUILDER SEPWNQ.THE DESERT AREA FOR 18 YEARS ROCKSCAPE SPECIALIST 347-5959 P.O. 80X 1047 INO O LIC. #348768 Lu Wrougti� . Ocoe I i . �. -move 7S rst Lucky