003373 (RPL)P.O. BOX 1504 'No.� 003373
Building ' : 78-105 CALLE ESTADO
Address 78-174 CA= NOSE LA QUINTA, CALIFORNIA 92253
Owtfer
J. STEFFY
Mailing BUILDING: TYPE CONST. - OCC*. GRP..
Address SAM A.P. Number 763-022-021
City ZipTel.
"I.. -92253 ,_ Legal Description -
Contractor Project Description PCNL & SPA
'BASM- T C01=0"'
Address
1179 MAY OR
.. City. .. ..Zip _. Tel.. '
P is .4� 92262 327 231
State Lic. City
& Classif. 514801 B C53 Lic. # ,�24 } Sq. Ft.'' No. No. Dw.
r + r�r Size Stories -Units
' Arch., Engr., . .
Designer_ st3t'3: New ❑ Add ❑ Alter ❑. •.Repair❑' Demolition ❑
Address Tel.
STIM -DO . .....
City Zip State
aPAIM SPROGS 92262 - ... Lica# - 14614 •
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. 1 r�
SIGNATURE - DATE
OWNER•BUILDERDECLARATION _ ' ,' 1.
Estimated V21UatlOn
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. 14,700
permft to construct, after, 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'. ..-PERMIT AMOUNT
the provisions of the Contractor's License Law„ Chapter 9 (commencing with Section 7000) of - - .a-
"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 five hundred dollars ($500). '
❑ I, as owner of the property, or my employees with wages, as their sole compensation, will Plan.Chk.. Bal... . 71.S2,
do the work, and the structure is not intended or offered for sale. (Sec. .7044., Buisness and ' COf1St. 11� 5th
Professions Code: The Contractor's License Law does not apply, to an owner of property.who , ta•
builds or Improves thereon and who does such work himself or through his own employees, ' Mech16.00
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 Electrical `
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. . Plumbing ' - 12 X00
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 am exempt under Sec... - B. & P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that' 1 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 231.34
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS',COMPENSATION INSURANCE +' `
(This section need not be completed if the permit is for one hundred dollars ($100) valuations �•� '
or less.) -'
I certify that in the performance of the work for which this permit is issued, I shall not - ' p ' f> •' �J'a k C'? c ,^iFfch.,.C{'�.'}-t{ .A 16
• employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date .. Owner
NOTICE TO APPLICANT: If, aRer,'making this Certificate or Exemption you 'sh`ould become ZONE: -
subject -to the Workers'. Compensation provisions of the Labor 'Code,' -you must forthwith ' MIf11mUm Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
Front Setback from Center -Line
Rear Setback from Rear. Prop.. Line
coNSTRucrloN 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. 11
I certify that I,have read this application and state that.the above information is correct. Issued by: Date9/16/•8? .-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 in purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
city, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT, ®
CAR P. SO. FT.
WALL SO. Ff. ®
SQ. 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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @.1114 c
SEWAGE DISPOSAL
Gu t
Zr k��
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
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 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
Gu t
Zr k��
/
G �7/� ,
v '
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
f
t
t
t
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9