10956 (AR)f44
f P.O. BOX 1504 - � o. 10956
Building7$2 Sia ''4 T � 7&105 CALLE ESTADO
Address g� i;�E: LA QUINTA, CALIFORNIA 92253
Owner r.
Mr . /Mrs a Lawrence Rhea
Mailing BUILDING: TYPE CONST. OCC..GRP.
Address same A.P. Number
City Zip Tel.
La Qu,lE1ta 92253 Legal Description
Contractor Project Description
William K. Fritz
Address. Enclose atr i 3izrt and acid living area
54550 Avenida Velasco
City Zip Tel.:
1,; Pia i 1nt_A 92253 564-64041
State Lic. City
& Classif. B 594854 Lic. # 1123 Sq. Ft. 482 No. No. Dw.
Arch., Engr., •
Size Stories Units
Designer New ❑ Add'❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel. "
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION,
I hereb affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of ivision 3 of the Business and/.Professions Code, .and my license is in full force and
effec!
t. ti.. r� . _ � � �1 "a. i i.
1GNATURE DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 35,668.00
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 its issuance also ..
requires the applicant for such permit to rile 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
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 rive hundred dollars (S500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.- Bal. 210. 28
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.323. �
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, Mech. .
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 t�-f
of proving that he did not build or Improve for the purpose of sale.) ' 3 1 .87
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con•. Plumbing
strucl 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 S•M.l. 3,60
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
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.).
Policy No. Company x L
Copy is filed with the city. 0 Certified copy is hereby furnished.. `
TOTAL 569.25
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 ifany perrso
Calonian in any manner so as to become subject to the Workers' Compensation
Laws of.
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 forthwith
comply with such provisions or this permit shall be deemed revoked.
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
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.
(,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
REMARKS.
enc--s'nn ;.r:. r�fi�tyh d13:_[4,.E3^ 5i'r
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. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SO. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
I IPOWER 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FINAL INSP.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vo 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 l Vi V
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE T
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.'o 9
ROOFING S
VENTILATION
REMARKS:
'
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ` Z2co/
MESH p
INSULATIONISOUND ILV
FINISH GRADING
FINAL INSPECTION
.CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
Lawrence V. Rhea
CITY 0d�91�9TA
n DEC 3'0 RECD
9!2 :a v- BUILDING AiND SAFETY
- # z -736P
T
..
. r
78230 Lago Drive, La Quinta, California 92253, (760) 564-2642