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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 .