9510-021 (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. Class s Exp. Date Eat' 7
Date n ; Signatureof Contractor r h4r.
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 & Prof gsinnnls rd -da)
() 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 ain rt.a ,, ;,DPolicy No. p4 .&- I ') .-0 " ^�,
(This section 'need not be completed if the permit valuation is fo $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 th Se pfrovisions.
Date:.. a / Applicant
t
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 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
above-mentioned property fori • pecti • n purposes.
Signature (Owner)Agent) ,7 Date t L, ,--
ALCM
BUILDING PERMIT
PERMIT'
DATE 101619:4
VALUATION SUn"(IIJV.j[LOT
TRACT
JOB SITE ADDRESS
APN
X57 --)iii WA. FUM, tiME
OWNER CONTRACTOR
19UNPITSF FOOLS
47-960 VIA FIR.ENZE PALM DESER:i CA 82260
SAN BN Ft. ARMN, CA 92408 61,93405521
"3916007 DESIGNER(ENGINEER
USE OF PERMIT?��
POOL AND SPA
FEE DESCRIPTION
FEES
CONTIUkC T AMOUNT 12,�.00 LS
`
0STIPUTED (.'08T OF C'ONSTRITCTIOi+l
SUWF'U'CAL CONSTRUCTION AND PLAN CHECK
5333.60
LESS .ETRE,-;PAID FEES
TOTAL PURM.IT l+EEN s)ilPN(1W
��3ai.dr3
' d
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
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
o
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
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 p
6 7
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:
/e> - In - 4s
ha w.
MEMORANDUM
CASE: Location(a):,
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 I to the property,
including such factors as size, shape, topography, location or
surroundings that Justify approval of the adjustment., These
circumstances are:-1WC,-aAfj Pao/
Thank you for yo r cooperation.
Sic ely,
Co�Mm Department
Attachments'.
c: Building and Safety.Department
✓I�
CITY OF LA QUINTA
PLANNING & DEVELOPMENT DEPARTMENT
APPLICATION FOR SETBACK ADJUSTMENT
CASE NO: f T.
.3 �� r
FEE:' $100.00
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: ,t,,),2 i nDO<-S DATE OC-7,-
CONTACT
ma,
CONTACT PERSON ( IF DIFFERENT) PHONE 3yUZI
MAILING ADDRESS: P0 - �2'
(Address) (City) (State) (Zip
OWNER'S NAME: R_ jiyy 44 PHONE 12-1!i
MAILING ADDRESS: y �iCrx) l%lfil /1/OOeP �-G), C4. CRL2- 3
(Address) .(City) y ` tate) r �(Zipj
STREET ADDRESS OF PROPERTY:
LEGAL DESCRIPTION OF PROPERTY: LOT # jL TRACT '="�"------
ASSESSOR'S PARCEL NUMBER:
ii
ADJUSTMENT REQUESTED: D�C�UC
l
REASON FOR REQUEST:
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 the adjustment is requested.'_
FORM.013/CS
r
Pv�- ��
POOL SL
P/L v�UL� POOL AF
POOL PE
DEPTH
COO NG
TLE CH, .
28 POOL C
PLR -1P Cf
b POOL Pu
FLTER
i FILTER F
/ TLpWOVF
VAC/SK!
Yo RETURN
MAN DR:
SKIhT•ER=.
I,l J FLL DE%_
HEATER:"-
— GASLNE'
P/L LIGHTS -P
nME a(
ELECTRII'-
POOL CL
EXI5ffNG RE5IDENGE CHLORN_
F-1 47-960 VIA FIRENZE DNNG 81=
LADDER'
LA OUNTA, GA SLDE
O POOL EOLP.
ROPE RW
C� ACCESS
• CfiADNG
DECKNG
CONCREI
' RAISED E
SCALE
^�I DAN AND MARY ISE'
.
47-q(0 VIAFRENZf
LA QLWTA, GA
. 9 14 R ,9(419f V
SUNRISE FOOL:
- C&FORW LIMM NO c
.y,`i'. =�.r�:• �.� ' t 3 �" a~„�r�cf•i - < ":irfY APPxQ�i®er;
,• , ISI u:•V,e•. .. ! .. �.®®�� THS M i`K7
REPRODUCTION OR MAUR
r~ 'i�g.�,r' • PERMSSION tk PROHBRFD.
- I t• t)e� I� ` 0 x POOL SEZE ~ 14.28
A00 AWAVOW
P1L �If v� POOL AREA, 342 SO, FT.
POOL=FERIMETER"88` LINEAR FT.
TO 5
TILE CHOICE -- "GROUP II-.
28 POOL` CAPACITY ' ''Aff. 10,000 GALS.
,. PUMP CAPACITY qO GPM
7. �. POOL PUMP i` 15 ULTRA FLO FIP
FILTER QUANTUM 175 SOFT.
} FILTER RATE 175 GPM
TURNOVER, APPROX.4 HRS.
VAC%SKIMMER =�' "1-1/2 / 2 N.
�l
�' RETURN.: LEVE -I . - ... - IN.
_ MAIN' DRAIN ANTI VORTEX
i DEGKING j /v SKIM`ER MODEL DUAL PORT
FILL DEVICE MANUAL
HATER TELEDYNE 250,000 BTU
s GASLNE BY: 5UNKT5E LENGTH • 100 FT.
o/L LIGHTS -POOL 400' WT. SPA 100 WT"
TIME CLOCK WTEZMATIG 24 HR.
r ELECTRIC BY: 5UNKF5E BONDING 5UNRI5E
POOL .CLEANER N/A
EXV-. i NG KESIDENGE CHLORNATOR N/A
47—G(c0 VIA FFENZE DIVING BOARD N/A
u � I - LADDER N/A
POOL EQ •
O
�A QUINTA, GA I' SLIDE � N/A I�. i ; -
ROPE RINGS - N/A
C3>
'-'-ACCESS`.:-� `'.,'=. ti TRACTOR 60BGAT
13 GRADING - NONE STUB' PLUMB • NO
DECKING- 51JNRISE:=' SQ: FT.. 600
` CONCRETE REMOVAL BY: -'NONE
t' " RAISED' BEAM-tegGTH' N/A "HEIGHT
-t_D�AWING #
e
•
r ITY FLA U �_• _r
0 :.f. � I NTA `s : r _ Fav"Alw -rtv
'7 • S t. C- t i t:i{ ••.3-� ti�
` .. :x•t> . - rrw>� ..-U.:,'�Y.� '.a.;ts a.,...R Y• =.x.." ..,.�.. ..,,
' v' a r t
r ,. 47 NIA S
`. ,
aNT r
E ILD_IN�y& SAFETY D'EPARTME _
•,, �. LA'G21J�VTA+,GA..
•r a�r.,. .. .. d�`a'.. �,St.',,:C •� y .r� �: E if. Free ..". �., r1 : � - =:..ry : �:x •y, .�'""=q=.�`t. :ir.t + 4 ~ r n' ,.
�r NDfTI ~NAL'LYr
-
- :C •- r
® _ � _ _ g. ..-C�.. .s*n_i � 1�1,',i •.-. i; •i `r,^."c, „gin.. - �
.. ,.., _.m +Y ,.:. • ... .. a '..; .... •- s •"�' } 'y'tk .S.r_ .C'{'',."' � �1 '4' .". �:ua �• - •
}�- 61°I-56412 ..:...�..,��,__..�:::�,.� .�_:�_..�..=. ;° .�:,•.
.. _.. ,. • '.. . ...........•.—' • �. - .. _:+^F ^--' _- . _. �..�= _Y., •C.} .(/ A+.=..,�':.�'.•s' �k� � R. ^::. f S_ i .. C ._ __�Y.'� _._-_1V.�t� f$ - _,.._.1»'r,•.. '.•...�
L -
•. r .fes Y .1 :�_ ` • -.•^UL'!« r.• ,�.. . t.l: 1�b_'. _ + .. _. ♦•�^ }�'Y"IIft...�5'f_ S^_l^t;.'�':�Lr .:Y"4X1"!' >. -� . 'N �O}^!"'1�.:31L .SI^M -�Y aoY.+i•'^'r tY .r.
#.-� E• :�. ACCEPTED-F®R.CONS U �.. _-...�,-
Sl:, ; •. :. c:. - :. ; •.+ '_ r .: w .._', - • � . •-., , . _ .. _ - _.. � (?- „* rte• •'3'.i,�^:- Y . _ +<t.,�'-' "?,.'+'-c' . �i.: ,rc�•yt,:h..
"?� Y `�i Y
c _
.r
r .. ..ECT -ttw .-
h • � t ��• T INSTALLATION AS PER-�' -
r h,�
-„I•,r _; i _ . .. • r. 'F' ,. f. _ ,. a�..:.r�il gafi�.�, 41.E t �-tt
i' R! S LY^•:ia* .. y, ..r�, 1y.:} .i >.;f
r
_ 619 340.5521
.;n+.•-., .,4 , 1" , :` e •..:-,•' , •. - - 5.. {..a��f,�� - t.. gr - •h•,.+.?Y�sn•p,'p„•�H'#*'s++ii��1'�A'�i-�yd��.
SUHRISE_�R04LS PALM DESERT , `CA..L
. t . _ i " vi <,, ; � •.✓ �. n+5�i�+#�Ksdc..tr3`�,•>3xst�i�.c,el,Ya'1• C� �s��•.� •w;�•�._.y'•
i '4 «
a z _; ,, LICEfaSE N0053-556236
- :AND ALL PPLICABLE CODES
CAIJFORNIA'
�:, is .r• _ •• ... n: „ .. r _-.w•a,. -•t^" f r "/[ r _
't rsry i•' .Z ,? �S e: +}'i!.+:ice �. � ti X ,f t=�•+.�'•���:3�i-� _ �n..i�'j • «r ;.e"'�[':S'•ali"N..
r
s� rr• m
.a
„
W'4n ..i"�n• . "tac w++"r.•,.�.,.. „+ a r • . � t.'; »...:-;. „. • �.... '. _• < . .. _ :c• f.Y r- :.t;-T.� - +�'r ,.ra �2i.. -.5rir - NO, -
SIR x}7-"- ;;ccam�
i. �.. .. .. ..-.. _ -. ... ...... - huT ,: V.c.J ._o. r•.fi•:• _: -. . ,r,.- w+. - ." ,. ,u' +v..- �:: �t '�`.`_ �� fs.r., ,..r -.+x. .r _ r:v+.. r^. �= .'ii. .� -+•- - •r.ru.,.: +r
�s<
3- 5.+r. _. a. ..4: x _ „...x -..a'. _ v`•� Y .a-1+.. .t. t, s 4; .T."�4!is°•G
.3Ls ItY:
: • . . ..r• .- x +.,F -n' rw..t ... . }} .•rb:.: , .,• h:.(%. ._ ... s .. - ,.. ,•-, . .. SI. . '- : t ."' ',.r,, r. ����y(�' r �w -
1 ._, ._. •, r .. AI . C•♦ �;i.,. __.� '. .d Z ,r•i�:. .-.w1 L- .- .+t � .FCwS [: , •yr.. :.w7r„_» -L••-- ba l �SLrf. •: c,+i+�'- L .*� '�.'^...G.-•,' .M -t,.
•. . . t.j,,..�v-w.--�F .... c�.,�.L __ ._. ,-� .._ S, nS,TY'K--; .e .. ..1r.+� ✓As, -... Y.-.. t. . .,w ^5 ;. �Y,. _%ef'1.'_. V'Yi" rP.. �� •\\
DATE-.� . _ - � _ .:�+ �. >< �:: • �.�. .�- � :�.. �•�;:" 4,_� ..,.,... �<�•
+_ .. t'•.'£C•' •it ., r'±Ms . +i 2't^..:• ^:9'+Y•.•e .>,.:- < �~ _
-t,•-.,..; _.. ...., .. ... ..•, .� . .. - r . _..._ .: �,, y.:. -i.. .:,..-.."-....:. .. _ - t t•1,w sI's} - . �. di.n.. as4uif2i:'L+sFz�i4., • j_:y�,�a-. � '7•- ,,,�'. -•
.t.s. '_'3'.•.,:�' . ': _ _ _-r,. ` -`'•y�T �`,',-•� ..� ._.w,. yr�..amm- . .:.. . - :.�•:-.a , i' „r,t�:!,`5f:
_ ,:- r,- ,x.;=l'.c -k ..l:rs # •{•.. 4,i�i' tcsptr,.
®®� Tl �S : ORAWNG; 7Y SU�tISE.rP00LS. La
REPRODUCTION OR UNAUTNORM USE WITHOUT: WRITTEN
PSMWN IS PROHBITED., r. _ ,