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13-0858 (AR)54035 Avenida Martinez 13-0858 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000858 Property Address: 54035 AVENIDA MARTINEZ APN: 774-221-015-3 -000000- Application description: ADDITION - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 7520 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT DA A Dam. 7/29/13 Owner: LADNER KATHRYN ANN 54-035 AVENIDA MAR S e V `to LA QUINTA, CA 9225 Other struct in o C I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: License No.: --------------- Date: Contractor: r / OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I'am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 Icommencing with Section 7000) of Division 3 of the Business and Professions Code) or that; he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by arV#ppiicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: r I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and L the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - and who does the work himself or herself through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.). I !as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. ` 7044, Business and Professions Code: The Contraytors' State License Law does not apply to an owner of property who builds or improves thereon, and wp6contracts for the projects with a contractors) licensed + 1 pursuant to the Contractors' State License La I am exempt under Sec. P.C.B.&ni is ason Date: -" /o' -.t/3. l Owner: I hereby affirm under penalty of perjury th work for which this permit is issued (Sec. Lender's Name: Lender's Address: L9PERMIT :ONSTRUCTION LENDING AGENCY re is a construction IeAding agency for the performance of the , Civ. C.). Contractor: Owner 0wNL Q_ 3,L419- DITION . 2010 Lic. No.: --------------- ------------'----------------------------------— 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 and policy number are: Carrier no Policy Number E FOOTAGE _ I 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 becomesubject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. Date: Applicant: 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 1$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. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 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 application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 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 abov i ormation is correct. I agree to comply with all city and county ordinances and state laws relating to buildin yrtstrdction, and hereby authorize representatives of this cou ty_t enter upon the above-mentioned pe o ins p t n purposes. Date: Signature (Applicant or Agent Application Number 13-00000858 Permit ELECTRICAL 2013 Additional desc . . Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . . Valuation . . . 0 Expiration Date 1/25/14 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC DEVICES, FIRST 20 ------------------------------------------------------- --------------------- 23.83 . Permit REMODEL 2013 Additional desc . Permit Fee . . . . 70.07 Plan Check Fee .00 Issue'Date . . . . Valuation . . . . 0 Expiration Date 1/25/14 Qty Unit Charge Per Extension 1.00 48.6200 LS MISC REMODEL, 1ST 100 SF 48.62 1.00 21.4500 EA MISC REMODEL, ADDL 500 SF 21.45 ---------------------------------------------------------------------------- Special Notes and Comments convert existing 3rd car garage to. office space. per 2010 calif building codes. July 29, 2013 8:31:30 AM jjohnson. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, REMODEL 150.15 STRONG MOTION (SMI) - RES .75 Fee summary Charged Paid Credited • ti Due ----------------------------------------------- Permit Fee Total 93.90 .00 ---------- .00.' 93.90 Plan Check Total .00 .00 .00 .00 Other Fee Total 151.90 .00 .00 151.90 Grand Total 245.80 .00. .00 245.80 LQPERMIT Sin # City of La Quinta Building & Safety Division Permit # 110 P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: J7WS Owner's Name: A. P. Number: 77t f 9-14 0 js— 3 Address: cJ D3 `off i 'nom Legal Description: 3 (tit 13 019 City, ST, Zip: vl %oioZs3 Contractor::.......Yr} d , tWt— Telephone: «• " o ;}, . Address: Project Description: City, ST, Zip: /9 vi i)er Telephone:. State Lic. # : City Lie. #: Ix / S 5 ✓ C7` S • 'T Arch., Engr., Designer: ®` •` . e l dl -Lf 61 2a( Address: City, ST, Zip: Telephone: < k a>,..r•> Construction Type -.TR Occupancy: S `k;:;: s x State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 16.r— Sq. Ft : OBD #Stories: #Units: Telephone # of Contact Person: { Estimated Value of Project: S O APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready 1*correction" ' Plan Check Deposit Truss Calcs. Called Contact Plan Check Balance Tide 24 Cales. Plans picked up Z Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'! Review, ready for correctio issue . Zq Electrical Subcontactor List Called Contact Person 2 Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading U4 HOUSE:- ''' Review, ready for correctionsrissue Developer Impact Fee Planning Approval Call A.I.P.P. etc-ofpermttissue School Fees Total Permit Fees NO'S a0y TO 1'S& (" 7D-7113- FAA D-7113F AA Date 8/5/13 No. 31760 Owner Kay Ladner Address 54035 Avenida Martinez City La Quinta Zip Tract # Type Residential Addition CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune Palms Road La Quinta, CA 92253 (760) 771-8515 APN # Jurisdiction Permit # No. of Units 4�'AIV1:EDs�O BERMUDA DUNES r rn RANCHO MIRAGE b INDIAN WELLS PALM DESERT y LA QUINTA 4INDIO y� 774-221-015-3 La Quinta i Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 54035 Avenida Martinez 200 Unit 6 Unit 2 Unit 7 Unit 3 Unit 8 Unit 4 Unit 9 Unit 5 Unit 10 Comments Convert 3rd car garage to a/c office. At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: Residential Addition 500 Sq Feet or Less EXEMPT This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of $0.00 X 200 S.F. or $0.00 have been paid for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Exempt - Kathryn Ladner Check No. Bank Name/Recipient of Certificate Telephone 760-668-5086 Funding Exempt By Dr. Gary Rutherford Superintendent 77 Fee collected lexe t d by On ilvrey Payment Recd $0.00 t.;Over/Under. Signature C = �, NOTICE: Pursuant to Government Code Section 66020(d)(1), this I serve to notify you that the 90 -day approval period n which you ,may protest the fees or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued; or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting IreMin ww % t , s / 1 P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760) 777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits Ply ORT'.91 D NOTIC TO pROPERTX OWNER Dear Property Owner. An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information Verification Foran to make you aware of your responsibilities and possible risk you may incur by having this -permit issued in your name as the Owner -Builder. We will not issue a branding permit until you have read, initialed your understands of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OM ITS ACIQN0-WLE1)OM qT AND'VERMCATION OF ZrfiFORNAMN DIRE ONS: Read and initial each statement below to signify you understand or verify this information. 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder'' bi ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those uilunes• I am willfully acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers onm property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the truction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect if from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on its and contracts. 5.1 understand if 1 employ or otherwise engage any persons, other than California licensed Contractors, and the total value o nay construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. I understand if I am considered an "employee" under state and federal law, I must register with the state and federal goverment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial Vrisk.1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential es cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. e8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be hey liable, for any f ancial or personal. igjaries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. kig, . I understand I may obtain more information regarding my obligations as an "employer" from the bAernal Revenue S, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand 1 may contact the California Contractors' State License Board (CLB) at 1- 800-321-CSLB (2752) or www.cstb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially responsible . for proposed construction activity at the following address: ! 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all *plicable laws and requirements that govem Owner -Builders as well as employers. l2_ I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I h e provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license,. the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court- It is also important for you tounderstand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property,, you may be held liable €or damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are property licensed and the status of dair workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing.the,permlt. : A copy of the property owner's d'river's , farm Kot a or other verification acceptable to the.agen rs required to be presented when the permit is issued to verify the pr+aperty owner's signature. Q Signature of property owner Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder- _ L - AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understandis my personal responsibility, I hereby authorize -the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Buildet Permit for my project Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature_ Property Owner's Signature: Date: M K.a IJ. LA d Kt r July 10, 2013 To City of La Quinta Building Department Attached please find my application to enclose the 3rd car portion of my garage and make it a part of my living space. This space has always been used as office with a temporary "wall" having been placed at purchase by the builder. The portion of the garage that is being enclosed was originally designed for the option of either a 3`d car garage or enclosing it for a living space. The space has 4 original electric outlets, a light switch, and window. It also has air conditioning originally vented to the space. Recently I was advised by a contractor friend that the current situation was a serious issue in the event of a fire in the garage. At this time my desire is to bring it up to code and make it a safe living environment. We will be enclosing the opening with 2x4 studs, 16" on center with 5/8 fire rated (one hour) drywall, or per your specific requirements. The new space will be 200 square feet Other than some closet racks, no other work is being done in this space. The space will be utilized as a closet, storage and office (cloffice ;). Since it is a minor job, a contractor friend will be doing the work. Since he no longer maintains his license I am applying as an owner builder. He was a general contractor for over 30 years so I am very confident in his work. I hope you can process this application quickly since now that I am aware of the fire issue, I am a bit nervous about the current situation. Thanks so much, D 540-5AVevUdA MAYti,weZ - l -i QjAwtA, CA -9225 X60 668-5086 -... J PQrtiCD _ MQS-cer Beolrroor-, i a I 20 ' ` Lx[9 N5 U t AJT s T - QU. - enc,, s rpt - • - ;' _ il 0 LA QUINTA Ed MING & SAFETY DEPT. ]APPROVED I --J- - - / (,0 — X lot-, wA N S (, CeI CINs I/i S okI to v - L _ BY October 17, 1996 Mr. Jeff Hines 1215. Munevar Court Cardiff, Ca. 92253 Re: 54-035 Avenida Martinez Dear Mr. Hines: Please accept this letter to verify some questions about the energy compliance of the dwelling at 54-035 Avenida Martinez. You will also find enclosed a copy of the permit issued for the project noting the permitted square footage. As we do not keep on file plans or calcs for single family homes for more than the ninety days required by the building code, we cannot provide any Title 24 documentation. The dwelling was reviewed and inspected under the provisions of the 1988 code cycle and met; as the job card indicates, those requirements. Regarding your questions about air conditioning tonnage for this dwelling, the Uniform Building Code is silent. The Code only addresses heating requirements, and the energy calculations are concerned with the efficiencies of the equipment proposed. Air conditioning sizing is left to the discretion of the Mechanical Contractor, who can address any questions regarding the sizing of the HVAC system Please feel free to call should you have any further questions. _ . Sincerely, Mark Harold Building and Safety Manager n k' t. fC' June 20, 1995 T-ity 4-4 Qumt 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000 FAX (619) 777-7101 Kay Ladner P.O. Box 928 La Quinta, CA 92253 Dear Kay: Thank you for your letter of May 16, 1995. Upon a departmental review, I have learned that we are unable to amend the code without a specific topographical, climatic, or geographical reason. However, for future construction projects we will do our best to coordinate with the builder the maintaining of adjacent properties and neighbors privacy during the plan check process.. We believe as we maintain a decent working relationship with most builders that this will be possible if discussed at or prior to permit issuance. I am aware this is of no help to you now, but may make the construction process better for others. Thanks again for you information and input. Please do not hesitate to contact me any time I may be of assistance to you. Best Regards, BUILDING AND SAFETY DEPARTMENT Mark Harold Building Inspector 11 MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 922531 May 16, 1995 Mark Harold Building & Safety Dept City of La Quinta 78495 Calle Tampico La Quinta, CA 92253 KAY LADNER P.O. Box 928 La Quinta, Ca 92254 J R E C E 1 , ED 7 hil 1127 [Y OF LA QUII4TA CITY CLERK Dear Mark r :. I understand that you are approaching anew code cycle' and will be reviewing the municip4l.code.. As you know; my privacy and security has been breached by the .construction of'a new home behind me Ile Builder has been far. from concerned or interested in my requests to fence the rear.portion of the lot. during -construction... We have.been unable t6 use-and_enjoy our backyard, during the construction. of. this home:? -The home is being:built on a foundation approaainately S feet above ours, anyone can look down .into my yard and,windows not to.merition_that they gain access by just jumping dawn into my yard. . We Dave -no privacy. or security. I believe the city should take into consideration.that this problem will continue to exist as long as new homes- are. being built on -raised lots such as. this one. I would like'to suggest that -you add something to the new code that would address the privacy and security factor of the existing homes when prm eits are issued for new homes. Thank you. for any consideration you can give -this concern. I understand- there is nothing.you can.do for me at this time, but maybe in the future we can avoid the inconvenience for others. 54035 Avenida Martinez cc; Cty.Couricil ::.. T" AA 4e JOY A - 'CIO 0 '7- Building Address Owner ,"C4V0ff 4 * Rum P.O. BOX 1504 APPLICATION ONLY 78-105 CA'LLE ESTADO LA OUINTA, CALIFORNIA 92253 Mailing I / /J Address '( 5'e,w f i"" 1nY 1-1'we Cit Zip Tel. 7 _ f_f e n ,tom -1 )/2_,o -e 7 1111,45o Y 1 Address I/ %Z,j v %Z VIA ,'ri/ City Zip Tel. f -2-,,C24 &-yam 1 9zZ7a G/q 3Zg zz? State Lic.City & Classif. ', gs/ Lic. N Arch., Engr., Designer Address Tel. City IZip I State Lic. If 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 Professions Code, and my license is in full force and effect. JIQNATt1RE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec. 7031.5.Susiness arse Prolessans Code: Any city or county which requires a Permit to construct. alter. improve, demolish. or repair any structure, prior to its issuance also ,owfos 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 DZi an 3 of rhe Business and Professions Code. or that no is exempt therefrom, and the basis for me alleged exemption. Any violation of Section 7031.5 all any applicant tar a permit suibwls the applicant to a awl penalty of not more than live hundred dollars (S500). I : 1, 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 bulls or improves (hereon and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sae. If, however• the budding or Improvement is sold within one year of completion, the owner -builder will have the burden of Praying that he did not build or improve for the purpose of safe.) I; I. as owner of the property, am exclusively contracting with licensed contractors to con- struct the prolect. ISec. 7044, Business and Professions Code: rhe 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.) ' I am exempt under Sec. B. & P.C. for this reason 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 (1 COPY is filed with the city. ! : Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed d the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of Ih8 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, alter making this Certificate of Exemption you should become sugect fo 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: TYPE CONST. A.P. Number Legal Description L, Project Description ✓ OCC. GRP. 0* lQ L Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line _ Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ INSPECTOR _ Issued by: Date Permit Validated by: Validation: Estimated Valuation __ ------ PERMIT AMOUNT Plan Chk. Dep. 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 INSPECTOR _ Issued by: Date Permit Validated by: Validation: / /% ` %moi G r✓' X I STI►QG 7✓t ('C r`: MSrT i J Z