11039 (AR)4
P.O. BOX 1504 N o . 11039
Building
Address 49 '329 Vista Bonita -LA QUINTACCL CALIFORNIA 92253
mr/Mrss Kessel
Address same
City Zip ITel..64
La QuiAt 92253 •-0997
Contractor
G. Scrivens Construction
Address
260 Pinyon
City "
stn Center
Crest
zip92361Tel.349a-33.27
LDING: TYPE CONST.' OCC: GRP.
P. Number
Description
:t Description ROOM' Add1tio.n ,�..
State Lic.
& Classif. P 521 3�.3
Cit
Licy#
Sq. Ft:
Size .• 135
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ "`Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following9,990.00
reason: (Sec. 7031.5,tiusiness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 Business and Professions Code, or that. he is exempt therefrom, .and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars.(8500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure isnot intended or offered for sale. (Sec. 7044; Buisness and
Professions Code: The Contractor's. License Law does not apply. to an owner of propertywho
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, as owner 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 contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
- . PERMIT
-
AMOUNT
Plan Chk. Dep.
-
.
Plan Chk. Bal.
76.05
t.
Const.
1 a ne►
137.00
. 'Mach.
Electrical
19-72
Plumbing
S.M.I.
-'�(�
Grading
Driveway Enc.
Date -�) Owner :d A,- Infrastructure
WORKERS' COMPENSATION DECLARATION _
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.) �,�-� 4,R<yof; _ (y ��1'.�,51"r
Policy No. Company 1�:r w f,03t, fU fad i 0F i
piCopy is filed with the city. ❑ Certified copy is hereby furnished. C.
TOTAL 213-47
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) 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: ff. 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 it work thereunder is suspended for 180 days.'
I car tity 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
REMARKS.
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 Perm
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 SQ. 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 DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
ITEMP 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 ® 11/. c
SEWAGE DISPOSAL
`( `
SO.FT.GAR ® Vic
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE ,
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE I PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP. (IR�G
FRAMING
FINAL INSP.g p
ROOFIN
`( `
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING -212hl
MESH
INSULATION/SOUND V
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
SANTA ROSA COVE ASSOCIATION
EXTERIOR ARCHITECTURAL / LANDSCAPE VARIAN C�E REQUEST
j11-1) L
n
Owner's Name
.,AR -32q 40MJ� Cc!baa
Property Address
City, State, Zip r
Request Number
5.2c-qr
Date
-32 q c U
Mailing Address
in ( i i;n r�i . 0 4 Q229 ;
Mailing City, State, Zip
Qq -OE �(ny -L-Qg7_
Telephone Number - local Telephone Number - permanent
The following modification is proposed and approval is requested for an ArchitecturaIA-andscape
Variance in accordance with the CC&Rs.
We have attached the necessary documents as outlined in the procedures sheet. We understand that,
if approval is granted, we will be responsible for the costs of said modification and any and all damage
which may occur to any common area property including but not limited to. sprinkler systems, utilities,
buildings, lawns, and plants. We understand that the Architectural Committee may impose additional
restrictions or obligations of the homeowner which shall pass to successive owners of the property and
as a condition of approval, applicant .for the variance will be required to execute a written agreement
and a notice of that agreement using the attached forms for recordation. We understand that the
recordation will be at our expense. We further understand that all building modifications require the
approval of the City of Le Quints and .that modifications shall be performed by a licensed contractor.
The cost of the approvals and permits will be borne by applicant. We further agree that, if approved,
the modifications will be made in strict compliance with the plans submitted with this application.
TYPE OF REQUEST: Please -provide a complete narrative description of the proposed modification,
including soecific materials, color, and dimensions.
Contractor Ucense Number
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CITY OF LA QUANTA
40d BUILDING & SAFETY DEPARTMENT 4
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L CONDITIONALLY �
ACCEPTED FOR CONSTRUCTION
I"�oo
10 SUBJECT TO INSTALLATION AS PER ,Yt �' 9Nl� i 7
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