11000 (MISC)f
`'•. P.O. BOX 1504 No. 11000
&1
Building 705 CALLE ESTADO
Address ���� � i�ejQ LAQUINTA,CALIFORNIA 92253. '
Owner
Mrs. Slausen
Mailing BUILDING: TYPE CONST: " OCC: GRP.' -
Address saarn€?.
A.P. Number
City Zip Tel.
I,a Quinta 92253 564-'-4077 Legal Description
Contractor. Project Description
.Steffen
Plumbing
Address _.. Gas Lineie install wall
P. ®. BOX 6112 heater
City Zip Tel.:
Indo 92202 345-4353
State Lic. City
& Classif. C36 565175 Lic. # I I Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units -
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zi� f/ State x-
Lic. #
�% I ENSEDyCOf� R7►CTOR'S DECLARATION
I hereby affi that I a licensgAn er provisions of Chapter 9 (commencing with Section
7000) of Divis'on 3 of.the-Business�, d`Professions Code, and my license is in full force and
effect.... - e.. 1f91\
OWNER -BUILDER DECLARATION
Electrical -
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
.
reason: (Sec. 7031.5,Susiness and Professions Code:. Any city or county. which requires a .
'
' struct the project. (Sec. 7044, Business -and Professions Code: The Contractor's License Law.
Rear Setback, from Rear Prop. Line
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that hes licensed pursuant to •
PERMIT
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 bas's
• 0 I am exempt under Sec. B. 8 P.C. for this reason
for the alleged exemption. • Any violation of Section 7031.5 ,by 'any- applicant for a pemu
plan Chk. De p.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
❑ I, as owner of the property, or my employees with wages as:their sole compensation, will
Validation:
do the work, and the.structure is not intended or offered for sale. (Sec.' 7044, Buisness and
Const.
Code: The Contractor's License Law does not appy to an- owner of property who
builds..or improves thereon and who does such work himself or through his own employees.
M' ch.
provided that such• improvements are not intended or offered for safe. h, however, the building
1-,050,00
orimprovement Is sold within one year. of completion, the owner -builder wi0.have'the burden
Electrical -
- of proving that he did not build or improve for the purpose of sale.) - .,
Distances:
❑ I, as owner of the property, am exclusively contracting with licensed contractors to cow
Plumbing
' struct the project. (Sec. 7044, Business -and Professions Code: The Contractor's License Law.
Rear Setback, from Rear Prop. Line
does not apply to an owner of property* who builds or improves thereon, and who contracts for
S•M.I.
such projects. with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Side Setback from Property Line
Grading
• 0 I am exempt under Sec. B. 8 P.C. for this reason
Issued by:
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. I nsu rance, or a.certified copy thereof. (Sec. 3800, Labor Code.) .
Policy No. Company
1!kopy is filed with the city. O Certified copy is hereby fumished:
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE,
(This section need not be completed if the permit is for one hundred dollars (5100) vahration
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 forthwim
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a.constructioh 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. '
1 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
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
15.00
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. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. 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) Z
U
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ 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
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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) Z
U
ETER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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 SIGNATURES/INITIALS
GARDEN WALL FINAL