15753 (PLBG)q 7_5 CALLE 013I5P0 P.O. BOX 1504 No. 15753
Building�A;78-495 CALLE TAMPICO
�� � a nh
Address 5®"inq* St. LA QUINTA, CALIFORNIA 92253
Owner Roxie Yessayian
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address P.O. BOY 1511
A.P. Number
City Zip Tel.
La Qainta ,6 CA 92253 Legal Description
Contractor Project Description Sewer Connect
Valley Plumbing
Address
P.Op Box 665
City Indio, CA Zip Tel.
92202 247-'3629
State Lic. City
& Classif. C-36 273€ 88 Lic. # 141 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City 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 of1�j�^^e Bu�siineess and rot ssions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following "s'-1,500.00
reason: (Sec. 7031.5,8usiness 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 PERMIT AMOUNT
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 Plan Chk. Dep.
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 Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon mid who does such work himself or through his own employees, Mech.
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 Electrical
of proving that he did not build or Improve for the purpose of sale.)
❑ 1, as* owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
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 S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
0 1 am exempt under Sec. S. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
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 NoZ company
4eopy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed N 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.
Dale Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: • BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Ce
Rear Setback from R p. Li
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setfrom Ce
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE /lam
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback Prop y Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a buildin FINAL DATE �I SPECT
g 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. Issued by. Date \ Pe yr lit
1 agree to comply with all city and county ordinances and state laws relating to.building CIO
construction, and hereby authorize representatives -of this city to enter the above-. - l7'
mentioned property for inspection purposes. Validated by: \ /
Signature of applicant -Date-
Mailing
ateMailing Address Validation:
City, State, ZIp
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES b
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB. -
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWE R '000 .
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT.
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT.
GROUT
WATER HEATER
WALL SO. Ff.
FINAL INSP.
DRINKING FOUNTAIN.
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
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,TEMIPERM
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.
SO. FT. RESID ® 1+/e c
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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
SEWE R '000 .
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
A %' FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
Y.U: BOX 1 SO4
LA QUINTA, CALIFORNIA 92247-1504BUILDING'& SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
May 3, 2005
Ms. Esther Sanchez
Riverside: Courity,Assessor's Offiee
3255 E. Tahquitz Canyon Way
Suite 114,
Palm Spr1ngs,`CA92262-6962
Dear Ms. Sanchez:
Please be"advised of an address change. for the foilowmg .structure The, structure
formerly addressed as -50=970 Washington"Street, APN ,.770 105=00L"U)t 87, MB
021/61-62, Desert. Club .Tract:Unit No. 5, is:now addressed as: 50=975 Calle.Obispo.
Please make a note this change: If I- may be of further assistance-you`m4y contact me
directly at (760) 777-7074.
Sincerely;
Therese Vell&Finorio
Senior Secretary .