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SFD (9702-042) + BLCK (14465)53280 Avenida Madero 9702-042 14465 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Qhaoler 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 Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury 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). lK I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). (') I am exempt under Section B&P.C. for this reason Date r ' •` 4 - " 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 Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). 1 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 ode, I shall forthwith comply with those provisions. ate: 2. a. - • Applicant K-­4`21- ° ✓. <. .. " .1w, 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. , -f 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, 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 for inspection purposes. ? ignature (Owner/Agent)"''`Date BUILDING PERMIT PERMIT# CONTROL# G 1L 1 ►. ► 4737 DATE( VALUATIONs11ti;•,tz 54) LOT TRACT JOB ADDRESS —280 AV,1s;1VIDA MAl ERO APN 774-0344HU OWNER CONTRACTOR / DESIGNER / ENGINEER JUT: W S &;,1,Gk11 S P Y KONG f NMI11t/ BU11... MIR +:Af X._;A.TZ Y A1,8 [STA 112.i'OM ' CCILN USE OF PERMIT i:'.aAt7D.i.:la`t'iui i ;.i: , t t. 1•'.1"tL t F t7isVii:)li5i<.Y.i; ,'.i; iti l .f%isi2ri fi ° # 1 f3r; . . PW, v1fT 1:tGrfa3 1 CYr,IN(*IAJ1)E L;1,.CBc:K WAIA.S _jk POOL. k'CiR (PAT1C:) X00 SP QA,R.AGfYr'A[0)0I0' - 411omo Sh, Fi 'T. WOOD FIE. ICE: 200.00 LF a i►►i ItL .il;%!< wv i t" i t w ✓:slier. 9.1.©i ` S PERMITFER, „ ,,.w,,,,... ,I.ii I.i CON.STRUCT1019 FI R 101-000-448-UC?O ii t1,S{i )1. 01 043CK FEE M► °". AWt1IJ'i.81 i01-0).421-000 5tiu.fii) i.3srl t ltl: 11. 161-000-420-/US>tW S 3147 P%,i1i1.?# MI ti61 10) -OM-419-CM S)27" ;31'ON N1G'1'Itrx+i .i:h - WSW lot -OW -241-000 $1051 (KAIDINO f• fsh 1:01-000423--000 $21 0. PRECISE- P1 AN s2s.0 Ai p 1?d P011,1E:1>LACR'S - RES! t : 701 -000 -255 -WO 1D , " A€. CONV'TRUC:"1 O AND PIAN CHFCK FEB ` t 1 9! l,ril?2 L LE x ; PRE— AID > 1 1. 4250.00 CITY OF LA QUINTA'0-FAT, 1pFRMU 1+',1.+:RWOUIk: NOW $1,352.29 Y RECEIPT DATE BY' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR 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 p -G,") 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 1 -31 -4 - Final Final BLOCKWALL APPROVAL/S POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam - 'l Approval to Cover Equipment Location Underground Electric Underground PI . 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 Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough WiringZ Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ` X14•.+- g //31 J TALVI u!'Gv P.O. BOX 1504 APPLICATION ONLY Building7&105 CALLE ESTADO Address 5 3 a _d k. , Vp ,gyp ,r 1 4{,, LA QUINTA, CALIFORNIA 92253 Mailing Address City Zip Tel. Contractor Address *City y Zip } Tel.: "ry _ S ,?" f • F S l •S>yp. <_. '. t` . 2 7 m Ate- `f" State Lic. City & Classif. Lic. # Arch., Engr., Designer ' Address Tel. t City Zip } State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provision's of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. - - - _SIGNATURE - 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 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). " FJ 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 0f proving that he did not build or improve -for the purpose of sale.) I: I 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.) i7 I 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM g- 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: 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 of 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. 1 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 BUILDING:. TYPE CONST: OCC. GRP., A.P. Number Legal Description Project.Description KI r Sq. Ft. No.- No. Dw. Size, Stories Units - New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. co Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 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 14'INSPECTOR F i Issued by: Datd Permit Validated by: L Validation. 5 1997 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES N0. PLUMBIC 4^, FEES 1ST FL' SQ. FT. @ $ 2ND FL. SO. FT. POR. SQ. FT. @ GAR. SQ. FT. 0 CAR P, SQ. FT. WALL SO. FT. !9i SO. FT. @i 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.IEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID Ccs 1'A c SEWAGE DISPOSAL SQ.FT.GAR @! ?Ac 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 & 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.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 FINAL INSPECTION CERT. OCC. FENCE FINAL matte vn a ananH vnca mi iAw GARDEN WALL FINAL , Trusts + "OMP" OrderNo.. Escrow or Loan No. r WHEN RECORDED MAIL TO: John,W. S. Kong and Agnes P. Y. Kong c/o'Lee &Kong #630, 112.4th Avenue S. W. Calgary, Alberta T2POH3 Canada RECEIVED FOR RECORD AT B. O'CLOCK JAN 211997 9,Mdo m ow'doi per+ Ed rrvemhie 0QuAt1- 1'0'44 -54me RepordOr Fes. F" SPACE ABOVE THIS LINE FOR RECORDER'S USS LOi MAIL TAX STATEMENTS TO DOCUMENTARY -TRANSFER TAX $ None X Grantee was the foreclosing vendor; consideration $ 73.1021. 5 Y Same as above unpaid debt $73.021.51 ; nonexempt amount $ None Computed on the consideration or value of property conveyed; OR •--•— 5 aTgllCrlTTibI TiL'e5 - remaining at time of sale. First American Title Insurance Company _ APNix 774-034-002=3 Signature of Declarant or Agent TRA: 020-015 TRUSTEE'S DEED UPON SALE FIRST AMERICAN TITLE INSURANCE COMPANY, a Corporation, (her®in called Trustee) does hereby grant and convey, but without covenant or warranty express or implied, to John W. S. Kong and Agnes" P. Y. Kong, husband and wife as joint tenants (herein called Grantee) the real property in the City of is • Quinta r County of Riverside State of California, described as follows: See Exhibit "A" Attached This conveyance is trade pursuant to the authority and powers vested in said Trustee, as Trustee, or Successor Trustee, or Substituted Trustee, under that certain Deed of Trust executed by Hank Czeranski and. Johanna Czeranski, husband and wife _ as joint tenants as Trustor, recordodNovember 2, 1994 , as Instrument No. 419866 in Book. -------- , Page of Official Records in the Office of the Recorder of Riverside County California; and Pursuant to the Notice recorded. September 18, 1996 as Instrument No 356430 in Book, ---------- , Page ------ of Official Records of said Country, Trustee having complied with ail applicable statuatory requirements,of the State of California and peifromed all duties required by -said Deed of Trust including, among other things, as applicable, the mailing of copies of notices of sale or the publication of a copy of the notice of default or the personal delivery of the copy of the notice of default of the posting of copies of the notice of sale or the publication of a copy thereof._ At the time and place fixed in the Notice of Trustees Sale, said Trustee did sell said property above described at public auction on January 17, 1997 to said Grantee, being the highest bidder therefor, for S 73, 021.51 cash, lawful money of the United States, Dated: January 17, 1997 FIRSTAMERICAN TITLE INSURANCE COMPANY, STATE OF CALIFORNIA } ss. as Trustee COUNTY OF Riverside } On January 20, 1997 bmfore me, the undersizued personally appeared Wayne A. Roy -- --- -- — By - _---w^_- Wayn Roy, Assistant Secretary personally known to me (or proved to me on the basis of satisfactory evidence) to be the perbon(s) whose name(s) is/are subscribed to the ANNEMTE M. CLARK within instrument and acknowledged to me that helshefthey executed the • COMMISSION #10602642 same in hislherAheir authorized capacity(es). and that by his/herAheir N VEr SDEOUN7Y Public• Gaillo y 3 signature(s) on the Instrument the person(s) or the entity upon behalf of , . ly Y ChI o Smr *slonG which the person acted, executed the Instrument ° MAY 28, t8t)1rea WITNESS my d and officiiallssea l. (This area for official notarial seal) Signature / j =- 2076(1!94) MAIL TAX STATEMENTS AS DIRECTED ABOVE LEE & KONG BARRISTERS & SOLICITORS TELEPHONE: (403) 233-9432 #630. SUNLIFE PLAZA EAST FAX NO. (403) 237-9614 112 - FOURTH AVENUE S.W. OUR FILE * * * CALGARY, ALBERTA T2P OH3 97 recom JSDK YOUR FILE CANADA February 19, 1997 FAXED COMMUNICATION 1 619 777 7011 . THE CITY OF LA QUNITA Building Permit Department City of La Quinta, California Attention: Building Permits Desk/Intake/Issuance i Dear Sir/Madam: RE: Property: 53280 Avenida. Madero, La Quinta I represent the present Owners pursuant to Trustee's Deed upon Sale. The matter was dealt with via foreclosure. I am transmitting the Deed which has been ,duly recorded by the Registrar for Official Records.of Riverside County, California. Please note accordingly and expedite kindly the issuance of the building permit for the above noted property, Should you have any queries or concerns ,please contact the undersigned. Sincerely, L & ONG Per: JOHN S.. KTG JSDK/jh [ko,ng/.recom;01412"97] attach. 1* .,_ CITY OP-L'A' QIJINTA ^iPt r Y r SUB -LIST- '11 u .,' , _ .. .. F - - .v .1S 4y i t L . ` .^t l '• t.,. p ti t A: (. t , w•'r• +, CONTRACTOR OWNER JOB ADDRESS This form_ shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that ' are on this list .are the same persons performing the work. Any changes to this list. must be approved the City of La _Quinta Department of Building & Safety prior'to work 'being performed by a changed sub - 'contractor. Failure to comply will result in a stoppage of work and/orAhe voidance of building permit. A/C -12 EXCAVATE .. ...:.... P[PEL111fES:::>::>::>:>>>; C-34 a .... .. cONCRETEI... C-8 7T EOUNOATIE3N$ t ASPHALT <> A y ' - B ..- C51 STREJCTURAL .. .';ter. .....; :MASONRY C-29 ,. PLUMBING' .. .... CZe2 n S' C-36 S 2. jo ' STZ-3/- .. , ; ... DRYWALL -. / / Pff G/ 2 /3 - C 9' - X39 9r 'tl7A%D F 2 0 iI O 3 a ....... ;,PLASTERING .... L : C -36p ►q S HVAC!✓ i'SS-2-/1A7i - C-20 9. / V/V. N - -97 'ELECT,:..:..:.:..L ReLr/gNce t Gee S RO`OFING ... :' C S- CeN- C-39' I - s 19 - 3-! SHEETMETAL C-43 ` f ELO'ORING' .. C-15 GLASSI> >;>>>> C-1 y GL4Z1:NG> > > .. ....................... .. INSULATION <> C77707 "R C C-2 -r- SEWAGEDIS:P>€> _................ _............. C-42 PAINTING/ C-33 ► - i -9s DECORATING : eS S /Z / 7 TILE _. 4 CZ 25/ i Gov " _, „G=54 SaZclo _ -9viv `I:c7' / _ BI CANETS/e/Ljf/ 5; / .' ev y :'r C-6 ` ; b? 90 g S' 9T2 T UN d 2-0 s/ INSTALLATION..:.:::. _ •r ws' FE.NCING:.::` > > : G ye/L/ nYSk (. Cc, Al C=13 .• c% S? / T .. vyA LD LANDSCAPIN CZ e2NS, i .cu, ,5 .. G27 y A', — AIP -Q .... POOLS ..:...:.:.: C 53 _ OTHER ....:.: ST, L-tc.. C tTq i t C. { L)L- s A/C X77552 io4 E -P ITI3oh-, w 12/31147 ujC.,X,P UNLCA24- SooCgS f 1-i74 exe I/I/q1 fh January, 28, 1997 Mr. Hank Czeranski 31-750 Landau Blvd. . Cathedral City; Ca. 9223.4. Re: 53-280 Avenida Madero Dear Mr. Czeranski: Per your request during our conversation today, .the following items must be provided to continue construction at 53-280 Avenida Madero, permit number 14346: 1.`New plans to meet the requirements of the 1994 Uniform Building Code. 2. New. Title 24 calculations which meet the 1995 Standards. 3. Plan review and applicable fees. 4. Construction fees based upon valuation. 5. 1994 Mechanical plan review and applicable fees. 6. 1994 Plumbing plan review and applicable fees. 7. 1993 Electrical plan review and applicable fees. 8. Strong motion instrumentation fees based upon valuation. Please anticipate approximately two weeks time for plan review. Infrastructure and school fees are not required for issuance as those fees were collected at the time the original permit was r issued. Please feel freeto.contact me should you have any questions. Sincerely, . Mark -Harold Building and Safety Manager. 1 CITY OF LA QUINTA vvv ■v ■ . .9 -ONTRACTOR ys=/ 'v^' ` ' ' ADDRESS )WNER ILIV/cS 14, Nr ^ JOB ADDRESS. S'3 2 d phis form shall be posted on the job with the Building Inspection Card at all times in a conspicuouslam. t is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that are on this list are the same persons performing the work. Any changes to this list must be approved the. --ity of La Quinta Department of Building & Safety prior to work being performed by a changed sub- :ontractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. PIPELINES C-34 CONCRETE! C-8 FOUNDATIONS .«< ASPHALT ........:; :' A FRAMING,.<... B STEEL! . ; .:`... .. C-51 ;STRUCTURAL..:..::; C-29 PLUMBING: c2 2 NS'.ei I C-36 I z goy I STffT-r LATHING'....'x:: > `> C-26 i! T!G FvaD t1 DRYWALL:' / %!/J'2 Lia C-9 539 90 o PLASTERING C-36 :: !'. >_.n_,i.,/_c_,i,. .r,.-..-c._ ... .. ..---. - -_ yJ - .. Z..+fir .. -• .....+ +—+..r. ........+. .r w ..r . . . w.t - t r•.• b. ! ', a.p. _ . ,.. 1 - r s - . .. F •+ •rb— .. • . 1 •.w• _ _. I. - - .r--. vim. - + .f - 1 lk1i?' j! I 4 417" P.O. BOX 1504 .14465 BJilding : 3 • 78-495CALLETAMPICO ? , i Address ,f •af ero . LA QUINTA, CALIFORNIA 92253 ' Owneri :2k Mailing BUILDING:. TYPE CONST:•• _•..' -7' OCC. -GRP.. - Address 63--220 Ran -90 ltd. A.'P: Number City Zip Tel C` a z bra Ci,w r .%-A. 3223 322 -8085 Legal Description Contractor r 13fl > . of com, TAc1t d13' 6'- Y23.Cg:t Sa a l Project escriP - block `Address- City.. Zip Tel.` State Lic.ii9f & Classif..4 . :. City 2081' •Lic. # Sq. Ft_ No: No. Dw. Size Stories Units Arch. Engr ` °Designer . - New ❑ ' Add. ❑ =.' .. 'Alter ❑ Repair ❑.. Demolltton ❑ - - Address Tel. City77 Zip 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 Profe sfons Code; and my license ism full force'and effect. ., €w • r ,r.. /rr _.... ' .. ,. - .. .. ' - . NATURE .DATE OWNER -BUILDER DECLARATION, : ' - r I hereby affirm that I am exempt from the Contractors License Law for the following reason: "(Sec.. 7031.5, Business and Professions Code: Any :city -or county which requires a'.4 ' 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 w '. the provisions of the Contractor's License Law, Chapter 9 (commencing with Section , 7000) of... - ' Division 30f 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): 0. 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. or 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 or sale.) Estimated Valuation 3 '25t •. j' _ •.:: PERMIT. AMOUNT - - I Plan Chk..Dep'. _. -• .r Plan Chk. Bai- Const. •_ ? - Mech. `. - • ' '. . - Electrical' - - - Plumbing ` ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-, • struet 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.). --❑ I am exempt under Sec. B. & P.C. for this reason - '.S.M.I. * - - • - Grading Driveway Enc. Date Owner. Infrastructure WORKERS' COMPENSATION DECLARATION " 1 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 O Copy Is filed with the city, . ❑ Certified copy is hereby furnished. • . .TOTAL. - fir 3 •' " CERTIFICATE OF, EXEMPTION FROM . WORKERS' COMPENSATION INSURANCE','. •. REMARKS ` - - - (This section need not be completed if the permit is for one hundred dollars ($100) valuation - . 'orless:)- I certify that in the performance of thg work for which this permit is issued, I'shgy not employ any person in'any marmrsoles.to become su61ect.to the Workers" Compen§'ation' Laws of California Date owner'' _ m - ZONE: BY: ' Minimum Setback Distances: 'r v;'• -. - , Front Setback from Center Line ; NOTICE TO APPLICANT: d 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: ' ' Rear Setback from Rear Prop. Line 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 ($100,000), IN -ADDITION TO THE COST. OF COMPENSATION, •• DAMAGES AS PROVIDED FOR IN SECTION 3706 OF•THE LABOR CODE, INTEREST, AND - ATTORNEYS FEES. - This is a building permit when properlyfilled out, signed and validated, and.is subjecPtb ` expiration it work thereunder is suspended for 180 days. Side Street Setback from Center Line Side Setback from Propert/ t f /- -• FINAL DATE INSPECTmQ u - I-certify.that I have read this' application and state that the above Information"is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby. authorize representatives. -of this city to enter the. above-. ' mentioned property for inspection purposes. Is$Lied by. Date ` nP rmlt •. ,, ._ Signature of applicant Date Mailing Address validation: _ City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMB.r: ;' 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. 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 STORAGE TANK WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROCK STORAGE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED METER LOOP LAUNDRY TRAY AIR HANDLING UNIT CFM OTHER APP./EQUIP. KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB WATER SYSTEM SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1 Va c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ec HOUSE SEWER FINAL INSP. ROOFING GAS PIPING PERMIT FEE REMARKS: PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEET��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. FRAMING FINAL INSP. ROOFING 7 //��,�/� //e���'" 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 CITY'OF LA QUINTA DEPARTMENT OF PLANNING & DEVELOPMENT BUILDING DIVISION 24-HOUR NOTICE FOR INSPECTIONS •777-7153 CITY Of LA UUINTA* OwnerHank Czeranski �_ 0 ,� !j L U '' v Contractor Same Pwmk Number 14 4'6 5 - POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES . JOB ADDRESS •53-280 Ave. Madero '130' of 6' high combination bl6ck wall TYPE OF INSPECTION DATE INSP. ' FOUNDATION & SETBACK .5 .FOO.TING STEEL /Z -Z .MAIN GROUND SYSTEM _ '! ,,GROUND PLUMBING . PRE-G_UNITE DO NOT POUR CONCRETE UNTIL ALUABOVE ]HAS-BEEN SIGNED_ . CONCRETE SLAB JOISTS & GIRDERS. ELECTRICAL GROUNDWORK y- DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING 4 ROUGH GAS & GAS TEST HEATING & VENT- A/C FIREPLACE '!ROOF llr;gOND BEAM O':K. TO WRAP " GROUT ❑ 4' ❑ 8' FRAMING INSULATION PRE -ROOF . COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE ;,y'SEWER SEPTIC TANK ' ,; . ELECTRICAL 4 , ABOVE APPROVALS DO NOT INCLUDE,RIGHT TO �� • TURN ON UTILITIES OR OCCUPY BUILDING s 4,88 i _' =•�•t�.+.' ..v•--.. Vii' • a -.-.,w