11433 (SFD)r n
i
414
P.O. BOX 1504 N o . 11433
Building52--(i30 Villa 78-105CALLEESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Sark Cernich
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 31866 Camino 773--234- 001
A.P. Number
City Zip Tel.
Car)istrano I92657 1714/601-r-069 Legal Description Lot 22 Slack 23
Contractor r : ff1 .. .! Li L;
} j tiProject Description
tt;t��!
Address. ..-
City Zip Tel.:
State Lic. City f
& Classif. 279413 Lic. # Sq. Ft. 1525 No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition. ❑
Address Tel. Permit dogs not include block wall or
City Zip State pool
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 Professlons-Code, and my license is in full force and 4
N
SIGNATUREr, DATE
TOWNER -BUILDER DECLARATIONS Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following89,790.30
reason: (Sec. 7031.5,Business and Professions code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to 8s issuance also AMOUNT
requires the applicant for such permit to file a signed Statement that he is licensed pursuant to PERMIT '
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 -� n
for the alleged exemption. Any violation of Section 7031.5 by -'any applicant for a permit Plan Chk: Dep -1 t. 250.00
subjects the applicant to a civil penalty or not more than five hundred dollars ($500).
[1I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 2-58.23
do the work; and the structure is not intended or offered for sale. (Sec. 7044" Bussness and Const. ._594.50
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds nor improves thereon and 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 • 67
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical c
of proving that he did not build or improve for the purpose of sale.) ^G -64
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo- Plumbing,
struct the project. (Sec. 7044, Business and Professions Coder 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. I _ 0such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading F
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc. .00
Date Owner Infrastructure . 1982.03
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.
TOTAL "'3446.'-40 3196.40
CERTIFICATE OF EXEMPTION FROM REMARKS
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 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.
Date Owner
NOTICE TO APPLICANT.- If, after making this Certificate or Exemption *you should become ZONE: BY:
subjectto 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 Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line `
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information iscorrect: Issued by- Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
IST FL. SO. FT. ® $
2ND FL SQ. Ff.
POR SO FT ®
GAR. SQ, FT, ®
CAR P. SQ. 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
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
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
IWATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. C
SEWAGE DISPOSAL
BOND BEAM
SO.FT.GAR ® 3/ic
HOUSE SEWER
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 I` (Itt C
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUPH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE t(`t(
t� Lo
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. rl1 j j6v�/�
FRAMING O
^Q
FINAL INSP. O� X90
`�
ROOFING l` �a
lot to
(
_ n g/p/GnL��J
V7�/l% pC(t [ 1�1�`
r
�n
T�
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REMARKS:
VENTILATION
FIRE ZONE ROOFING ,
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING /
MESH
INSULATION/SOUND
FINISH G
FINAL INSPECTION — t'i
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
��'���+..'�j ..i'i'kw��,0.r!']/'kMi�l•iC�'R�W7lkby�i�1•+�F�{Tat��/ry-.�••�.4')2'Y��'s'rTp'vT1.'W7�T7•`.�•�� .�"Rt4�'M�R''71A�C� �� � ..
s 'YR•'> `
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL: !"! _ '�'0'A
Ti t) (o11 '°"5QLA Date r 1— C —fie -73
eceive rom. l /
Address: 1 - �Sfo O C - GL" N10AA)
AccountNo. toL L_ K' L-1 r9.5` f, C-) •Ca Lot(s) Tract
-S •
Service Address 71�-''I�i »l G.A. Code
LTJ Meter(s) ! — $
M' Service(s)
❑ Backflow(s)
❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
HCl' Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ InspectionFee- Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other ^y
TOTAL
Remarks:
❑ Copy to: s
>A Water Service VI -
!Check
ash �y`� „ f��`
t/ 4- ���one ep,` y � ` r� Cashierrder` CVWD-438(11189)
DESERT SANDS UNIFIED SCHOOL DISTRICT
a 82-879 Highway 1 1 1
NOTICE; Indio, CA 92201
Document Cannot Be Duplicated -(619) 347-8631
Date. 1 1/2/92 Type of Permit Le 00nta
•rm
No.
1-1809 P 1t •
Log .►
Owner NameMark'Cernich
No. '52030 Street Ave Villa
City La.Quinta Zip 92253 Study Are 112
APN. _ Tract j Lot '*E=- Square Footag 1525
Type of Development Single Family Residence No. o' units
Comments
At the present time, the Desert Sands Unified'School District does not collect,fees on
garages/carports, covered patio's/walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-nemed'owner is exempt from paying'school fees at this time due to the
.following reason
.EXEMPTION NOT APPLICABLE
4
This certifies 'that'school facility` fees imposed pursuant to Government Code 53080
in the amount of 1.58 X 1,525 or $2,409.50 have been paid to. D.S.U.S.D. for
the. property listed above and thet building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued. ,
Fees -Paid By La Quints Homes, Inc. Telephone 714-661-5068
Name on -the check
By James E. Lively1j
' Assistant- Superintendent, Business Services
r.
r
-Fee collected %exempted %tlokieJ. Durrett=_ r
Payment Re:eived �
Signeture
ZzLfi_ca,
Check �No."1020
;( ,r• .
Collector:. Attach a copy of county or city, plan. check application form'tV 'd'istrict copy for all
Embossed Original' Building Dept./Applicant Copy - Applicant/Receipt Copy - accounting .
.4 ,
Ap
Q4V
.,�
OF
1li�i�tltl c�Iti� fPt1tt.illlt
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building _
_Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For -the following:
BUILDING ADDRESS 52-030 Avenida Villa
Use Classification Single Family Dwell fng Bldg. Permit No.
Group R3 Type Construction VN fire Zone Use Zone SR
Mark Cer;zich 31866 Camino
Owner of Building Addiess
City San Juan Capistrano, CA 92657 By; Mark Harold
LI-7D,acember,:30, 1994.
Dote:
Building Official, -
- `' POST IN A CONlTICUOU! /LACI'
SNB
:MEN