08136 (MISC)Building
Address 49-274 Vist
Owner
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Mailing
Address
City "°' ' Zip
La Quiata
Contractor
AF HM49 Ccnstmeld
Address
A191
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P.O. BOX 1504 N o , U51-40
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC'GRP;.
A.P. Number Santa Rasa Cme
Legal Description
Project Description Atm fans A tights.
Add sky 11cfhts..
Tel.
City I I. - - Zip Tela '
Holith Wal ria 92258 340-2533
State Lic., City 854
& Classif. � Lic. # {
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l 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
SI WTURE' DATE
OWNER -BUILDER DECLARATION
I hereby _affirm•thabl.am exempt from the Contractor's License Law for the following
reason: (Sec.1703'1 5;Busfhess and Professions. Code: Any city or county which requires a
permit to-.constiuct: alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant forsuch permit to file a signed statement that he is licensed pursuant to
. the.provisions of.
`the. Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of'the Birsinessand Professions Code, or thathe is exempt therefrom, and the basis
fol the alleged. exemption. Any violation of Section 7031.5 by 'any applicant for a permit
i subjects the applicant to a civil penalty of not more than five hundred dollars ($500). "
El 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 safe. If, 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, asowner 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 to an 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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. 3�A .rr & ! Company e a e� r /�
IXCopy is filetl with the city. O 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 Workers' Compensation
Laws of California
Date Owner '
NOTICE .TO APPLICANT., It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .of this city to enter. the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 620/"Permit
Validated by:
Estimated Valuation
Validation:
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
'Driveway Enc.
Infrastructure
r
TOTAL
2& !If
REMARKS
z .U."ip: Aiii4l+l td: .f ' n;u A,65 i. a['?��. X5"1'& dNdA 41.
vx
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date 620/"Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYE14
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
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.C. UNIT
LOLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT K
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FI INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
- ,SANTA ROSA COVE,ASSOCIATION- ``-
EXTgERICR ARCHITECTURAL /LANDSCAPE-VARIANCE REQUEST'
` r y Request riurnL_r
Ha anr3 Marinnne-Matheson '1-2-91
;. Owners Name $ Date, a.
, _ tom• .
•. �lQ-�7Jd. Ave' Vi gi-A Rnni ta' I8i12 WakecreSt Dr.
`.` Property address- Mai ling.address
t
• _ Malibu. Ca 9026'5
Ta Qni-nta, Ca
' CAt ',State;Zip. Mailing.City, State,Zip a,
ti 56V4 3830 s 213-454-1692
W: .r.,
TeTephone number-local-, Telephone number-permanent' ,
The fol lowing ,m6di'f•ication'. is proposed and,-approval is requested .
fo;r an Architectural/Landscape variance in accordance with the ,'�
we have -attached the necessary; documents 'as-outl�i ned in the r '
procedures sheet. , We understand that, -if"approval i-s granted, we
be.; -responsible for` the'°;costs of ,said modification and any
end all damage �which`'may occur-to-'any common.' area`property
�`includi.ng
but not limited to;.sprinkler -systems, utilities,
".,bui-,Idings, lawns and plants.We understand that the A'rchite'ctural`
7.Committee may impose additional.,restri•ctions-or. obl.i,3*ations °of ti .
the homeowner which shall pass to .successive owners-.•5f the r`
property and as a conditicn of approval applicant for the
�,variance wi'l 1 be-required to execute ?a' written :agreeiient and u
, not,i ce of that agreement using' the' 'attached forms`. for
recordati;on.,we understand`that;the recordation•will'be at our
expense.we further understand,-that ahl' buildingtmodifidationS%'
requ i re-the approval of the City of La; Qu i nta and: ,that `
modifications shall'_'be performedFby,a licensed contractor. The '
cc's-t of the approvals and permi ts'< wi 11 be 'bo'rne -b
Y a�pPl• can � . we ' •
further agree thiat,..if• approved, the modifications Wi1.1 be made -
i n strict comp,l�i ante. with. the plans submitted with .th i-s ,`
*;application.41
i
TYPE OF REQUEST': ` See, attached `
' _ F Please provide a_complete narrative description
.1 rof -the proposed modification,'including specific mate rials,colo`r
.,
and dimensions
CONTRACTOR A.E. Howe - f .TELEPHONE NUMBER 34.0-26.33
CONTRACTOR L«ICENSE NUMBER, 293444- r, ,
- lam• .Cy/—f • . - ',�
Owners Si•g'nature
T
Matheson
49-274 Ave Vista Bonita"
1. Skylites in interior bathrooms.. (Low dome, self flashing with
recessed diffusers.)
2. French doors in entry.
3. Indirect, recessed lighting in,the livingroom, diningroom, entry
hall, bar, kitchen, master bedroom and bath.
4. Ceiling fans in livingroom, master bedroom, gc.est room, guest
house and patio. Patio.fan-has-a single light.
5. Marble floor tile s in kitchen.
6, Wall cabinets in garage.
7. Remove drop ceilings with plastic diffusers .n kitch and-
master bath.
8. Mirror walls in master bedroom and bath.
9. Replace shower-tub in guest room with larger...shower and glass door.