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9512-040 (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. 57412! A 8131/95 License #_ Lic. Class ., Exp. Date 'Date 1' a Signatureof Contractor .l', 1 -- '17-1 _ 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). ( ) 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 TrXIT FULdD Policy No. 124267M (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, 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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 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 is a result of this application becomes null and void if=1 ...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, 1. certify that I have read this application and state that the ab ve informationis/ correct:. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City topen4er upon the 'above-mentioned property for inspection purposes'. �Signaure (Owner/Agent) .. '+ rs,- ' i R� �� p � ALC' _-BUIL r ING PERMIT PERMIT1.5i 2.040 DATE T, ..... ION �� LOT TRACT JOB SITE ADDRESS 47 19 %0 VIA FIRENZE I APN OWNER CONTRACTOR S1 VF rjol how C—OWSTRUC')'ION G€I 1;1:1' }10'AE.�", CO, .tYl4Lr;'; T1 E S ;)88'05.F,, 0a.;Z.7 RD., #' 1:535 SOUTH D STREIP' li-200 C,t?;17HEDR—AL CfFlr CA 922.14 BE.RNA:R DINI - CA 92409 0-19324-1232 CBL,# 1044 /SAN DESIGNERIENGINEER USE OF PERMIT�(AL)L ANVIO SPA '311A.014LY REAR YARD SETBACK R)MUC110-N, APPROVED PER 3.}3.1193-365 FEE DESCRIPTION. FEES CONIRAC,"'t AA40U'N7 lt),06lf1.C►f! .LS ESTIMATED e;:,'OST OF CONSTRUCTION UC1`ION 3.t1,0iliD.dlp Pi1:;k1MIT :FFE SUMMARY PLAN C13'fs(;?C::F`f±; - t Q1 -i)00-4 3�-�.1 � $70:05 ' CONSTRUCTION ME 101-000.41.800 $117.00 WCHANICAL IFEE —POOL 101-000-421-00.0 $a 3.t10 F,L;13t" RI.CAT. FE6--P001, 101.-wo-11'10-000 PLLFA1 ING.FRE -,.'POOL 101-000-419.000 SUB.WrAL CONSMUCTION� AF ,)'fa PLAN CHECK $2x39.05 OLESST'itF;-}'A(1� FEES $t).OU © T0TA i'ERJMIT ' fE&S DU1e: t 010 $289.05 Q ? 1995 I 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 Final Final BLOCKWALL APPROVALS Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final �L S 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 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: aha w MEMORANDUM 4-1-7- 9S CASE: g5 =365 Locations) : 7 870 V P} Request (s) : _ 429-6^' u s., d Ave, i .J , 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:o„�� . After review it was determined that: 1. This adjustment.is consistent with the intent and purpose of r the Zoning Ordinance.' - 2. There are special circumstances applicable to the property, including such factors assize, shape, topography, location or surroundings that justify approval of the adjustment. These ► circumstances are: low 4n�c� ,�-w��.�i�r- 44,,1 Th511W you r your cooperation. S ely, Development Atta meets .c� B ldng 1 RECEIPT City of RECEIVED FR e_/ ADDRESS Quinta,'78-495.Calle Tampico, P. O. Box 1504, La Quinta CA'92253 ,D. TE - �,. 7 1' • 1370 3ubmittec by the owner authorizing the Applicant to. execute this ciocument Ln his; bE :alf PLEASE PRINT OR TYPE J� J j APPLICANT/CONTRACTOR: .5J11 (' ".'i� I S DATE 74 -ONTACT PERSON (IF. DIFFERENT)PHONE MAILING ADDRESS: DWNER'S NAME: MAILING ADDRESS: PHONE , ( �? (Address) (City), State) (Zip) STREET ADDRESS OF PROPERTY: .� .% (/ / /- LEGAL DESCRIPTION OF PROPERTY: "LOT # l TRACT ASSESSOR'q PARCEL NUMBER: /1 ADJUSTMEN REQUESTED:/�} REASON FOR REQUEST:' i r r -F-YZ�D"A .1)v_cv V 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 surroundi gs, that justify the approval of the. adjustment of the setback requireme.t, and that the adjustment will not .be detrimental to- the health, safety, and general welfare of the community or be detrimental to property n- the area of the parcel for which the adjustment --s requested. FORM.013/CS N 4' SHEER DESCENT - WATER FEATURE Residence RELOCAl`E� FROM POINT • " - SPA SPECS. GENERAL SPECIFICATIONS SIZE 7 X 9 SIZE X AREA PALM TREES FOR RAISED 18" " DEPTH ILLUSTRATION PURPOSES ONLY LITE WATTS EA. SHAPE PERIMETER TRI LEVEL SEATS TILE SIZE 22". 24" 27 TILE COLOR DAMWALL WIDTH N/A COPING. SPILLWAY.SIZE N/AX "COPING COLOR SPILLWAY POOL CAPACITY GALS PUMP CAPACITY 105 GPM GPM J,.. 'OPEN CLOSED X MOTOR HP 1_5 HP Stucco Side Walls FILTER MOD MEDIA 300 SQ FT and top t0 match FILTER RATE 105 GPM existing fencing TURNOVER HRS MXT 208 TILE WALL SUCTION LINES 1 MXT 08 TRIM TILE RETUR LINES 1 2 . MAIN DRAIN 1 •' UNDERWATER TILE TO BE COBALT PETITE SKIMMER MODEL U3 CHECK VALVE. 1 W/WHITE GROUT: IN STOCK IN DODSON PERSONAL WAREHOUSE HEATER LAARS SIZE 250 OOCBTU GASLINE BY SDC POOL LIGHT SPA LIGHT 2 @100 WATTS EA CLOCK .INTERMATIC \7'X9' SPA ELECTRIC BYpr ELECTRICAL BONDING BY: SDC RAISED .18" : * DECKMAN NOTE: TILE AND COPING SDC ** DECKING BY GREY SALT W/CAL 100# GREY EXPOSED EDGE SCORE JOINT BY -SDC** HEAVY AG IN FRONT CONTRACTOR cannot assume FLOWER AREA responsibility for damage to curbs, sidewalks; driveways, PLUS: cement slabs, sewers, lawns,trees, fences, retaining .� ' 49 S# OF BACK walls, sprinklers, telephone lines NTILEVER l' U or shrubs. When access is made f..YARD DECK through a neighbor's property it is ,� 1r understood that you, the owner, have that neighbor's permission 'CONCRETE . D' % and assume full responsibility. . " dame: WATERS, CHARLES&SUSAN 870 70 Of SP�N A'KER COVE LOT # 13 �1 L5� AnI IIIUTA P100/s SHOW ROOM NQQONER 73-011 COUNTRY CLUB DR. STE. F-4 PALM DESERT CA. 92260 POINT PHONE (619) 346-4032: LIC # A-574127 MIKE RICE