15364 (AR)Buildin
Address 78=021 Ldgo Drive
4,�
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Owner
AMOUNT
Mailing
Address same aro above
City•`
Zip
Tel.
..La Quint&
92253
Contractor
William H. Fritz
Address
5g-' 550 Avenida Velasco
City
Zip
Tel.'
Ira Quirita
92253
5614-6402
State Lic.
City
& Classif.. 594854
Lic. # 1123
Arch.- Engr.,
.Designer
Address
I 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 Business and Professions Code, and my license is in full force and �-
effect. •�•i 2 i �4+ :�
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,' after, improve, demolish, or repair any structure, prior to issuance also
requires the applicant for'such permit to fife a signed statement that he is licensedpursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing, with Section 7000) of
Division 3 of the the
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 rove 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 or 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 'reprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business andProfessions 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 contractors) Qcensed pursuant to the Contractor's License Law.)
O 1 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
❑ Copy is filed with the city. ❑ Certified copy Is hereby furnished. e
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. M, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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. . L .
I certify that I have read this application and state that the above information is correct.
1 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
LDING: TYPE CONST.
No. 15364
OCC. GRP.
A.P. Number
Legal Description
Project Description Add -golf cart garage
Sq. Ft.
Size
No:
Stories
No. Dw.
New ❑ Add ❑ 'Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 2391.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
35.10
Const.
54.00
Mech.
Electrical
17 44
Plumbing
S.M.I.
.24
Grading
Driveway Enc.
Infrastructure
..
TOTAL
J - w u a 0
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback fr/ \en'Line
Rear Setback ` f Rear Pro . Line '
Side Strtback from�C��er Line
Side ScA ck front 15roperty jnet
FINAL DATE INSPECTOR
Issued by: Date 9(Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. .ELECTRICAL FEES
NO. PLUMBfW FEES
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. @
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. @
OTHER APPJEOUIP.
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
LAUNDRY TRAY
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
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.
y0
ROOFING
/'
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING S
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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A.
• BUILD G DEPARTMENT
CI'Y`OF LA,QU.INTA
OFFICE: (619) 777-7012 INSPECTION REQUESTS: (619)'7i7.7153
TO:749-0-11/
� R DATE:
/
ADDRESS: 49' 0�
i. G�
CORRECTION NOTICE
PERMIT NO.
40//-
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