14868 (RPL)Building
Ad=tss 79--515 Mandarina
Owner Mr. Dan Hayes
mailing
Address Same
City Zip
La Quinita, GA 92253
Contractor
James Mason
Address,
P.O. Box .2774
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.'
Palm Desc>er t, " 92261 564-2431
State Lic. City
& Classif. A 413153 Lic. # 1185
Arch., Engr.,
Designer
Address
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
1000) of Division 3 of thp;Business,and Professions Code, and my license is in full force and
effect• L.,w ;a^f/' ... /.d►w„igr„ti„r+ ....
'SIGNATURE .r` !✓ " DATE
OWNER -BUILDER DECLARATION
I hereby form that I am exempt from the Contractor's License law for the following
reason: (Se . 7031.5,8uskmess 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 ($500).
❑ 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 sale. 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 bufkl 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) Qcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby firm that I have a certificate of consent to self -insure, or a certificate of
Worker's pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy r CompanY
(loc-opy is filed 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
alifornia.DateOwner
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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($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.
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
No. 14868
BUILDING: TYPE CONST. OCC. GRP.
P. Number
Legal Description
Project Description Pool and Spa
Reduction of street sire side yard
setback to 3= approved per SBA 95-295
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $ 2Q r OOO . Oa
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
134.55
Const.
207.00
Mech.
24.00
Electrical
45. 00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
437.55
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from -Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
gide *,et ck from Property Line
NSPECTORI
s ' /''I t o :♦
ted by: r —
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
7
2ND FL. SQ. FT.
FORMS
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS 1
CAR P. SO. FT.
OTHER APP.IEQUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR p 3/ac
HOUSE SEWER
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
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
f
INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESlINITIALS
GARDEN WALL FINAL 77d
N
3- l3 -q5
T4tit 4.4 Q mro
MEMORANDUM
CASE. 157 . V15 Locations)P)-
Requests) : 58 4vNy%-b <-c
`7- •716 3
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: 044110.4A , NA- .
,gym
eg AM- LA n
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 approval of the justment. These
circumstances are: } o. tial,.. Ac,+ , rao K Hn
Thank
S: fidere1
Attachments
your cooperation.
relopment Departmi
c: Building and Safety Department
G
CASE NO:
CITY OF LA QUINTA FEE: $100.00
PLANNING & DEVELOPMENT DEPARTMENT
APPLICATION FOR SETBACK ADJUSTMENT
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 ter must be
submitted by the owner authorizing the Applicant to execu t document
in his behalf.
PLEASE PRINT OR TYPE
APPLICANT/CONTRACTOR: DATE
CONTACT PERSON .(IF DIFFERENT)
MAILING ADDRESS: /SO X 2 i k
ress)
A<,,I- Q
(City)
PHONE \SC '72
1v7 F12 -S
(State) (Zip
OWNER'S NAME: 404,12 A7 QV.e_' : PHnNF.
MAILING ADDRESS •
(Address) (City) (State) (Zip)
STREET ADDRESS OF PROPERTY:
LEGAL DESCRIPTION OF PROPERTY: LOT # TRACT
ASSESSOR'S PARCEL NUMBER:
ADJUSTMENT REQUESTED:
REASON FOR REQUEST: S dW .,a -:t aZ 1 _e a k .
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
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