11050 (RPL)4
P.O. BOX 1504 N o , 11050
Building 7a—i2o Lago Ar$�ie 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
14r/Mrs Steve Yeager
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Mailing
Address- same
City
Zip
Tel.
La Quirta
92253
564'361.0
Legal Description
Project Description
Enclose 1
end of exiStinQ structure
Contractor
William H. Fritz
Address
install
glia
54550 Avenida Velasco
City
Zip
Tel.:
La Quinta
92253
564-6402
State Lic.
City
& Classif.
B 5)4854
Lic. #
1123
q, t
size 62
No. No. Dw.
Stories Units
Arch., Engr.,
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Designer
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 Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractofs License Law for the following
reason: (Sec. 7031.5,Busi7ess and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demoflsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to We a signed statement that heis 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 bast
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penaltyof not more than rive hundred dollars ($500).
O 1, 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 of 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 safe.)
Estimated Valuation
4,588
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
46.80
Const.
72.00
Mech.
Electrical
19.00
Plumbing
t�}
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con•
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. 8. & P.C. for this reason
S.M,I,
.50
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
keI hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worr's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy. No.Company
Otopy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
177.30
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of thg 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.
REMARKS
_
1 Or T a..f �." T LnAy
Date Owner
NOTICE TO APPLICANT. N, 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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
FINAL DATE
Side Street Setback from Center Line
Side Setback from Property Line
INSPECTOR
Lender's Address
This is a building permit when property 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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
IST FL SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. ®
OTHER APP./EQUIP.
DRINKING FOUNTAIN,
SO 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
FRAMING 72(ZI e `
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VTEMP
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
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+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE __JCONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN 5621
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. — 6—°Ili
FRAMING 72(ZI e `
FINAL INSP.S 16_c1 L
ROOFING
10
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
COOLATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTI 6-9
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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DATE
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CITY OF LA Q'uWl-,,fllA
BUIll—DiNC a SAFE DEPARTMENT
C -MI � CNALLY
ACCEPTE"D FOR CONSTRUCTION
SUBJECT TO 1NSTAUj%' ]ON AS PER
'►m c. � 1 �D�D -
AND ALL APPLICABLE CODES
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