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11286 (SFD)4P. O. BOX 1504 No. 11286 Building 52-420 Eisenhower 7&105 CALLS ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Frank Czeranski BUILDING: TYPE CONST. OCC. GRP. Mailing Address City Zip Tel. 1 1 Contractor Aaaress I saIP.e as above State Lic. I City & Classif. 502905 Lic. # Arch., Engr., Designer Address Tel. City (Zip (State I 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 DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors Lirense Law for the following reason: (Sec. 7031.5,Business 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 or 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 rive hundred dollars ($500). ❑ 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 will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ 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 ,r Date /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 O 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 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 subject to the Workers' Compensation provisions or 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 1 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 ateMailing Address City, State, Zip Number Legal Description Lot 14 Block 99 Book 18 Project Description SFD Sq. Ft. 6 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Permit does not include block walls or Estimated Valuation 97,264.80 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 283.50 Const. 630.50 Mech. 55.50 Electrical 131.26 Plumbing 144.00 S.M.I. 9.80 Grading 20.00 Driveway Enc. 00 Infrastructure 2150.21 TOTAL 3674.71 34L4. -11 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 1ST FL. SO. FT. ® $ UNITS A.C. UNIT COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. SO. FT. ® HEATING (FINAL) WALL SO. FT. REINF. STEEL DRINKING FOUNTAIN SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LUMBER GR. LAUNDRYTRAY AIR HANDLING UNIT CFM FRAMING a�L 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 ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER GAR. FIREWALL 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 SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE /!n �-Y GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING �cu. yd. $ plus x$ _$ LUMBER GR. �1 FINAL INSP. / a� FRAMING a�L FINAL INSP./;Z/ ROOFING[ Ct (� (�� Cl(I !1�L� pj// f �jj) � y� ✓ (!�C (�Y REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL ING Q W ME H INSULATION/SOUND FINISH GRADING FINAL INSPECTION 7 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Building 117 Address Owner e, Mailing Address City A (: PC Contractor fA! r. -I'll Address City State Lic. & Classif. Arch., Engr., Designer Address P.O. BOX 1504 PPLICATION ONLY / 78-105 CALLE ESTADO 4 f t.t LA QUINTA, CALIFORNIA 92253 , 0V ao.��, Zip �C All, Zip ' ]BUILDING: TYPE CONST. r� F OCC. GRP. 14qd A.P. Number fel. Legal Description—Z `�� /j) rt rf (Project Description n 5 Sq. Ft. No. No. Dw. Size Stories Units 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 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 thealleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mora than five hundred dollars ($500). 1 : 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 suchimprovements 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 ' 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.) I 1 I am exempt under Sec. B. & P.C. for this reason Date 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 r] 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 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 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 ✓.. T Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it 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 sof this city to enter the above. mentioned property for inspection purposes. • Signature of applicant '7 �� i� � �G' Date Mailing Address g, ' " City, State, Zip ' ` BUILDING DIVISION New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation7 4, qO Q PERMIT AMOUNT Plan Chk. Dep. +^� Plan Chk. Bal. 23 , Const. Mech. ! Electrical •� Plumbing Pf S.M.I. , Grading Driveway Enc. �Infrastructurr AL'OP 6" TOTAL a, j REMARKS of r x A-+ nom.... r+rl + 1 16� 110A it OT L F�275.OG 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 GROUND PLUMBING NO, ELECTRICAL -FEES ��� NO. PLUMBING FEES 1ST FL. SO. FT. @ $ SLAB GRADE UNITS _i •' - ' HEATING (ROUGH) 2ND FL, SO. FT. @ FORMS SEWER OR SEPTIC TANK YARD SPKLR SYSTEM DUCT WORK POR. SQ. FT. n FOUND, REINF. MOBILEHOME SVC. BAR SINK HEATING (FINAL) GAR. SO. FT. @ REINF. STEEL POWER OUTLfT ROOF DRAINS CARP. SO. FT. @ GROUT WATER HEATER DRAINAGE PIPING FINAL INSP. WALL SO. FT. @ BOND BEAM WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. S plus xS SO. FT. @ LUMBER GR. URINAL FRAMING ESTIMATED CONSTRUCTION VALUATION $ ROOFING WATER PIPING NOTE: Not to be used as property tax valuation REMARKS: FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD FIREPLACE SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER SPARK ARRESTOR GARBAGE DISPOSAL GAR. FIREWALL FURNACE UNIT WALL FLOOR SUSPENDED LATHING LAUNDRYTRAY AIR HANDLING UNIT CFM MESH KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY CERT. OCG. AMPERES SERV ENT SHOWER FENCE FINAL BOILER B.T.U. SO. FT, @ c BATH TUB GARDEN WALL FINAL SO, FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID @ 1+/. c SEWAGE DISPOSAL SQ.FT.GAR @ ?Ac HOUSE SEWER GAS PIPING PERMIT FEE T PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE .FEE PL,tyjr,.F� CONST. FEE� ETE SMI FEE LF��`� � j��� STRUCTURE PLUMBING ELECTRICAL HEATING R 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 APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. S plus xS =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCG. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL I/ i NOTICE:✓ Document Cannot Be Duplicated Date 8/12/92 No. 11645 Owner Name Hank Czeranski SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 Indio, CA 92201 (619) 347-8631 No. 52420 street Eisenhower Type of Permit I La Quinta Permit # Log # city La Quinta zip 92253 Study Area 113 APN # I Tract # 1 Lot # 14 Square Footage 1648 Type of Development Single Family Residence No. of units 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 11.648 1 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 Telephone ' Name on the check By James E. Lively n Assistant Superintendent, Business Services ✓'' Fee collected /exempted by Vickie J. Durrett a Payment Received Signature �� Chdck 'No�1708 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 ❑Copy to: Cash Check "j 1 Money Order COACHELLA VALLEY WATER DISTRICT ` CASH RECEIPT DETAIL Received From: `�- P. � t 5 M1 ( Dat a` Address: ~� _-� J t\ 1�Lt1 -! lC' U d. rJl L ' G. ti i�1'= G( V,0 Account No.( -, Lot(s) Tract- ract Service� �? �-- Service Address ' v--1 �._. � v1 :.`3 ` 1!!, ,i G.A. Code E3"Meter(s) T $ r ci J F'Service(s) ❑ Backtiow(s) y ❑ House Lateral(s) ❑ DetectorCheck(s) ❑ Meter Surcharge Sanitation Capacity Charge 4• ❑ W.S.B.F.C. ❑ Temporary Construction Meter (! ❑ Turn on Charge ! ❑ Uncollected Account -Name t - ❑ Inspection Fee -Tract - (tr Fee - ❑ Plan Check Fees Water / Sewer - Tract - '' 6c ❑ Bo6d,Payment - A.D. -______.,Bond i f Assmt. ' 1 ❑. Customer Deposit ❑ Other # TOTAL$ -.. / [ a� U J l 1 fk, ; tt Lir t'1 GY1 Remarks: l.s� ❑Copy to: Cash Check "j 1 Money Order CVWD-438 (11/89) Water Service 8 Cashier. CVWD-438 (11/89)