12311 (AR)4
P.O. BOX 1504
Building 54-322 Oak Tree 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Jan Spidell
BUILDING: TYPE CONST.
No. 1.23.11
OCC. GRP:
making
Address Same
A.P. Number
City
Zip
Tel
La Quanta, CA
92253
564-7404
Legal Description
Project Description
Room Addition
C ntractor
Kieffer Construction
A dregs
2-111 Velasco
City
iiia Quinta, CA
Zip
N2253
Tela
564-1309
State Lic.
City
1/0
• & Classif. B 5900590
Lic. #
Sq. Ft.
Size 1461
No. No. Dw.
Stories Units'
- Arch., Engr.,
Designer Paul Scott Anderson
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
ALddres'P.O. Box 277
Te�64:-p5Q3�
City Quinta, C�
Zip
92253
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed.underprovisions ofjElicenhapter9 (commencing with�Stion:
7000) of Divisioni3 01 the Businessen
,d ProUrssio s Code, andttn se is in full force -and
effect.
t'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,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 of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty o/ not more than five 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 o/ 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
o/ proving that he did not build or improve for the purpose of sale.)
Estimated Valuation
$10,000.00
PERMIT
AMOUNT
plan Chk. De p
Plan Chk. BBI.
76.05
Const.19.50
117.00
Mech.
Electrical
_
20.11_
Plumbing
❑ I, as owner of the property, am exclusively contracting with licensed contractors to c�oan.-
struct the project. (Sec. 7044, Business and Professions Code: The Contracto_'s,License`lw
does not apply to an owner of property who builds or improves thereon..&B who contracts for
.S.M.I.
• 70
such projects with a contractor(s) licensed pursuant to the,Contriotor's License Law.)
..r-�
❑ I am exempt.undec.Sec: & P.C. for this reason
Grading
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.)
Polii'cy N�� Company
L�I-Gopy is filed with the city. O Certified copy is hereby furnished.
; }
TOTAL
23 36
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed i/ 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.
—
;1
Date Ownerv
NOTICE TO APPLICANT: 1l, after making this Certificate o/ Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
compli with such provisions or this permit shall be deemed revoked.
ZONE:
Minimum Setback Distances:
v. '
:.
BY:
1
`
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
Lenders 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.
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Date Permit
Signature'of applicant Date
Mailing'Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
_$
URINAL
SO. FT. ®
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE G
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION
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
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 G
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL