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11689 (SFD)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 52-400 Eisenhower LA QUINTA, CALIFORNIA 92253 Owner Funk Czeransiki Mailing Address 67-220 Ramo Road. City " Zip Contractor Czer&nski Const3: uct.ion Address ty State Lic. SQ2�5 & Classif. Arch., Engr., Designer Address Zip City Lic. # BUILDING: TYPE CONST. A.P. Number 773L-271-008 No. 11689 OCC: GRP. Legal Description Lot 15, Block 99 Project Description SFD Sq. Ft.6 $ No. No. Dw. Size Stories 1 Units ' ,New`r0 Add ❑ Alter ❑ Repair ❑ Demolition ❑ Permit does not include block galls CityZip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70 130) of Division 3� ✓of /the Businessend Professions Code, and my licensee is in full force and effect. /` ✓c'lX�ai� e fr f p 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,Buslness and Professions Code: Any city or county which requires a 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 to the provisions or 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).' ' O 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 willhavethe burden of proving that he did not build or Improve for the purpose, of sale.) •� ` . O 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.) - ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby 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. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE, Z i (This section need not be completed If the permit is for one hundred dollars ($100) valuation Of 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 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 or pool. 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 Estimated Valuation FINAL DATE INSPECTOR PERMIT Date Permit AMOUNT _ Plan Chk. Dep'. •`` 250.Oa •. Validation: Plan Chk. Bal. fj '. ' 283.50 Const. 630.50 Mech. 53. s� Electrical 131.26 Plumbing 144.00 S.M.I. 9.80 Grading 20.00 Driveway Enc. Infrastructure 2, 250. 21 erec::ne P.Lan 25.00 TOTAL -3,674.77 3,424.77 REMARKS f n' -� P-2, 441 40,,,.,.(0--0r-91. jre 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. GAS (ROUGH) 2 ct G �L t DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM FINAL IINSP- WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM VENTILATION 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% c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac 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 0000, GROUND PLUMBING�I� .�� UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWERna/J( ROUGH WIRING, DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) 2 ct G �L t METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL IINSP- FINAL INSP. — GRADING cu. yd. $ plus x$ _ $ LUMBER GR. FRAMING--- ROOFING y� p� REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LAURI Cal 93CV MESH. INSULATION/SOUND L FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL c&ty�, 4 P.O. BOX 1504 APPLICATION ONLY Building99 / 7&105 CALLE ESTADO Address SC- ' l/�� �/ Sin ham/ LA QUINTA, CALIFORNIA 92253 Owner Mailing Address CityrZip t/ Contractor„ Address State Lic. I City & Classif. �'p Cf �) S EL # Arch., Engr., Designer Address Tel. CityI Zip I 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 Professions Code, and my license is In full force and effect. SIGNATURE • �' -/� r+,- t" J" 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 or Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 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 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 of sale.) I 1 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 contractorts) licensed pursuant to the Contractor's License Law.) I l 1 am exempt under Sec. 8. & P.C. for this reason A Date /_, I - 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 [7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or lass.) 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 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 DIVISION BUILDING: TYPE CONST. OCC. GRP. Number i Legal Description Z!, Project Description Sq. Ft. No. No. Dw. Size Stories Units New JV- Add ❑ Alter ❑ Repair ❑ Demolition ❑ ,timated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 1 _ 17Q5f.R 0 3878 12_28-92 14 TOTAL 1 7 SASW eJ CJ I HL 1 .1 17. VV 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. @ $ UNITS SLAB GRADE 2ND FL. SO. FT, @ BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC, BAR SINK POR. SQ. FT. @ DUCT WORK ROCK STORAGE GAR. SO. FT. @ POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APP./EQUIP. DRAINAGE PIPING CAR P. SQ. FT. @ TEMP. POLE WALL S0. FT. @ GROUT DRINKING FOUNTAIN SO. FT. @ FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.000L 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,TEM(PERM LAVATORY. HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB GAR. FIREWALL SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ I / c SEWAGE DISPOSAL SQ.FT.GAR @ 3ft HOUSE SEWER INSULATIONISOUND GAS PIPING PERMIT FEE FINISH GRADING 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./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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 112/30/921 Type of Permit Palm Desert No. 11929 Permit # Log Owner Name Hank Czeranaski No. 52400 Street Eisenhower City La Quinta Z I p 92253 Study Area 112 APN # 773-271-008 Tract # I = Lot # 15 Square Footage -11648 Type of Development I Single Family Residence INo. of units 1� Comments 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 or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 x 1648 or $ 2,603.84 have been paid to D.S.U.S.D. 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 Hank Czeranski Name on the check Telephone By Tames E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Vickie J. Durrett Payment -Received + Signature G� /�l , Check, No. 1929 Collector. Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./ Applicant Copy - Applicant/ Receipt Copy - Accounting COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received r I k -A-' Kms- MI ICA`=' From: Address: 1:-�� 3 L. 1�., it Account No. Lot Is _ Service Address Er Meter(s) �3 r B'Service(s) ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check (s) ❑ Meter Surcharge_ 0' Sanitation Capacity Charge 4' ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - r ❑ Bond Payment - A.D. - Bond Assmt. ❑ Other ,Remarks: ❑Copy to: Cash Check Money Order TOTAL $ 'DP:� --Z) 5- Z-/[ Water Service t Cashier. ' CVW 438 (11189)