11102 (RPL)ra
P.O. BOX 1504 �%/- N o .'O �.
Buildingtq78-105CALLEESTADO �✓
Address 48--537 is E canto LA QUINTA,FCALIFORNIA 92253
Owner
Ron Mawrocki BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address 48537 Via Encanto
A.P. Number.
City Zip Tel.
La Qui ta, 52253 564-53.34 Legal Description
Contractor Project Description
OTZier/Bua? der Spa
Address.
City Zip Tel.:
State Lic. City
& Classif. Lic. # 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 of the Businessy.and•Professions Code, and my license is in full force and
�y�, * < v
-SIGNATURE-' DATE
OWNER-BUILDER DECLARATION. Estimated Valuation. s�
I hereby affirm that I am exempt from the Contractor's License Law for the following 000
reason: (Sec. 7031.5,Business and Professions Cade: 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 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 rive hundred dollars.($500). -
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 5.10
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. Irj
Professions Code: The Contractor's License Law does not apply to an owner of property who . `" •
00
builds or 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. ff, 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 safe.)
OvI, as owner of the property, am exclusively contracting with licensed contractors to coo- Plumbing 21.00
Struot 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• • 3a
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason ,
Driveway Eric,.',
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 No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 16 4 .. D
CERTIFICATE OF EXEMPTION FROM REMARKS n zes n }3R AP, n I. A t.
WORKERS' COMPENSATION INSURANCE
This. section need not be completed if the ;):--,) - Y,,`T3,.. ° f� #,'- '(Yj }yX- -'•'�' - ' `t `a ' 'i' ��r
( p permit !s for one hundred dollars (E 1OOJ 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=msnner so as to become subject to1he Workers' Compensation
Laws of California. r_,,�^.•- 7-
Date
Date Owner
NOTICE TO APPLICANTfter making this Certificate of Exemption you should becomeZONE: 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 Center Line
Rear Setback fron 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 property filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
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. 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. FT.
POR. SO. FT. ®
GAR. SO. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR @ V4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES��E
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
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
JUNE2� 'D2 TUE : 1:3::'09 . MARQUIS MANAGEMENT P.02
AAAK4GFME4Tll,aAOUP -
33-9iS Date Pstm Drive. Suite 200
Carwdaal Baty. Gkkwhia S2?:Zrt
j (619) 324.7.= • FAX (819) 324-ima
LAGUNA DE LA PAZ
ARC ITECTURAL VARIANCE AUTHORIZATION
NAME NAL Ln s
ADDRESS Y i ts. ELS ('Ai`TC)
Your request for Archi � v.•{ ._� }.
tectural.Varia;nce has been approved
by the Architectural Committee. Any changes requiring a
Building permit must be obtained through the Citi' and must
Pass any City inspection. All chahgOs must Comply with
City and County Codes.
SPECIAL. NOTES=kt5�C'EnJ �c
•Ln Id C 1A5 L l &J C S A G 00 Ivy _T
=ate NAr)Nc01' f
Thanp you,
Nancy 8ua e `
Account Executive
� J
L7 REGIONAL OFFIC9S f
lone • Rancft Cucamonga • San Clemente soucn
Bay 9 Cosehelia %o�jt,ey . $,u1 Oicgc .