15356 (RPL)44
P.O. BOX 1504 No. 15356
Building 78-495 CALLE TAMPICO
Address 79-865 Horseshoe Rd. LA QUINTA, CALIFORNIA 92253
Owner Jake LaCroix
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address 79_865 Horseshoe A.P. Number
City Zip Tel.
La jQuinta 92253 Legal Description
Contractor Project Description' Pool Spa only
Western Pools
Address
43-375 Madison �t
City- Zip Tel.:
Indio 92201 3+47--59x9
State, Lic. . - City
& Classif. , 3487618 C-53 Lic. # 1151
Arch:,, Engr.,
Designer
AddressTel.
City Zip State
1Lic.#
I . : LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) t. of Division 3 of the Business and Professions'Code, and my license is in full force and
effec
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, alter. 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
the provlslons or 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 appikant to a civil penalty of not more than five hundred dollars ($500).
❑ 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 improve for the purpose of sale.)
❑ 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) i'Icensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need ,not be completed H 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 pperson in any manner so as to become subject to the Workers' Compensation
Laws of Callfornia. .
Date Owner
NOTICE TO -APPLICANT. It, 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 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.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. No.
Size Stories
New ❑ Add' ❑ Alter ❑
No. Dw.
Units
Repair ❑' Demolition ❑
ZONE: BY: '
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear . Line
Side Street Setback fr en Line
Side Setback from R, Lin
FINAL DATE
Issued by: Date
Validated bv:
Validation:
itimated Valuation. $17000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
M
7 * 00
Const.
$180.
00
Mech.
y9
,ilk
Electrical
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
a'►3
�. C3C�
REMARKS
ZONE: BY: '
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear . Line
Side Street Setback fr en Line
Side Setback from R, Lin
FINAL DATE
Issued by: Date
Validated bv:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWj FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CAR P. SO. FT,
WALL SD. FT.
SO 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
S
FLOOR DRAIN
MECHANICAL FEES
A.C. UNIT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FORMS
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 ® 11/4 c
SEWAGE DISPOSAL
SO.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 all ELECTRICAL a7 HEATING & AIR COND. SOLAR
-SETBACK
GROUND PLUMBIN
S
UNDERGROUND%
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. 'I
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC NK
ROUGH WIRIN
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.
ROOFING
•v3�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL