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12689 (SFD)7 � . r t i - P.O. BOX 1504 No 12609 Building .54-700 Avenida Obregon 78-105 CALLE ESTADO-.. Address LA QUINTA, CALIFORNIA 92253' Owner Yank Czeranski MailinBUILDING:;TYPECONST: • OCC: GRP. Address 67-220 Rang A.P. Numbera Road 774 —274-010 . CityZip Tel. Cathedral Cit ► 92234- 322-8085 Legal Description" Lot 10 Block. 267 C .traLcor SFD Project Description Address City IZip State Lic. B 502905 & Classif. Arch., Engr., Designer j Address Tel.: Cit Lic.#. 2091 Sq. Ft. 1646 � No. N . Dw. Size Stories Units c' New ❑ Add ❑ Alter ❑ Repair ❑• Demolition ❑ Tel. Perm t..doee rot inclUde block-,'vtalls City. Zip State Mi. •�J�4� ;.•'< , LIC. # r LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencipg with Section 7000) of Division 3 f4he Business and Profe`sslons Code, and my license;l's'in full force and r ffect. y - � . _SIGNATURE DATE ~ t •' OWNER -BUILDER DECLARATION I Estimated Valuation 19 F y f A ' I hereby affirm that I am exempt from the Contractor's License Law for the following 197,264.80 reason. (Sec. 7031.5,Busmess and Professions Code: Any city or+county which requires a permit to construct, alter, improve, demolish, or repair any structure,, prior to its issuance also requires the applicant for such 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 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 five 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 - - .PERMIT " Plan Chk. Dep:` Plan Chk. Bal. _ ns. ` Cot 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 build or improve for the purpose of sale.) Mech. ' Electrical - Plumbing'- - 111, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contiactor's License Law, _ '.S.M.I.- 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.). ❑ 1 am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc. —I.tgSP_E-C.T.O.R Date Owner } WORKERS' COMPENSATION DECLARATION ' I hereby affirm that 1 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. Company ❑ Copy is filed with the city. ❑ 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 manne sous to b e: subject- to the Workers' Compensation ; Dateaws of California. Date—Owner NOTICE F . NOTICE TO APPLICANT. If, 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 Infrastructure ;. TOTAL REMARKS 630. 50 r �" =gy 55.50 '131 .26 20.00 .00 21150.21- .77 3,424.77 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 DATEy —I.tgSP_E-C.T.O.R ' Issued by: Dat ermi Validated by: � 1 n nil • JNIV � U : y ,Validation: 6 j CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ, FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. lJ GAS (ROUGH)s a ��/ 7 DRAINAGE PIPING CARP. SQ. Ff. OTHER APPJEQUIP. REINF. STEEL WALL SQ. FT. ® TEMP. POLE 7 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.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ^ GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED REMARKS: LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER MESH 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 I PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING f -Zoo (f;ANDERGROUND A.C. UNIT COLL, AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWE� _ f OUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. lJ GAS (ROUGH)s a ��/ 7 METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE 7 GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ _$ LUMBER GR. FINAL INSP.6 &— ! FRAMING . / G• FINAL INSP.(y% ,.�� . ROOFING �--��p��J / /1 ^ REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL i/ LATHING _s C MESH INSULATIONISOUNY3 Q L/ FINISH GRADING FINAL INSPECTION,6—If/ CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 1504Buildin11�/ Addrress � fO 40 e v o "1_ LA Q 7&105 CALLE UINTA, CALIFORNIAORNIAESTAD92253 Owner a APPLICATION ONLY /9,.* 00 A `? G'� '� BUILDING: TYPE CONST. ..J /�.' OCC. GRP. Mailing g 7 l V Address �,'- -,'? 0 �a 2/ A.P. Number Cit sl Zip `� Tel p� d >1 457 4�U r �C f 1> �� ���� 4 ? �2� 3 � ,3 �C% — 8a 0 5 Legal Description .e�� •a Project Description R_ C City ! �,�; /#i� k Zip Tel. f - State Lic. & Classif. , S Q © City Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profess'ons Code, and my license is in full force and effect. _ C SIGNATURE r� - .r, _qtr'✓ A° "�7'S"/ •� DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such 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 Business and Professions Code, or that. he is exempt therefrom, and the basis tot 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 five hundred dollars (5500). 1] 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 build or improve for the purpose of sale.) I 1 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.) I1 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby 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. Company F) Copy is filed with the city. ❑ 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 (S100) 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: If, 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 BUILDING DIVISION Sq. Ft. No. No. Dw. Size Stories Units New Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. OLD Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 7_7 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 DA Issued by Validated Validatior CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES r 1ST FL. SO. FT. @ $ 2ND FL. SO. FT. @ POR. SO. FT. @ GAR. SO. FT. @ CAR P. S0. FT. @ WALL SO: FT. @ SO. 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 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. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 11A c SEWAGE DISPOSAL SO.FT.GAR @ 14c HOUSE SEWER REMARKS: VENTILATION 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 R 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 APPJEQUIP. 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 FINAL INSPECTION CERT. OCC. FENCE FINAL insrtc r una manor � une�rnr r rww GARDEN WALL FINAL