08-1744 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
--08-00001744
Property Address:
81454 RUSTIC CANYON DR
APN:
764-280-999-166 -300236-
Application description:
POOL - RESIDENTIAL
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
20000
C&tyl 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
--------------------------------------------------
CENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalt perjury that I a icen�59 der provisions of Chapter 9 (commencing with
Section 7000) of Division of the Business and P €s ' nals Code, and my License is in full force and effect.
License Class: 8 C27 9 icense No.: 656128
/ate: 0/ ontra.tor:
NER-BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code)'or
that he or she 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 five hundred dollars ($500).:
1 _ 1 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors'. State License Law.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
KOZOVSKI
81454 RUSTIC CANYON
LA QUINTA, CA 92253
Contractor:
TESERRA
P.O. BOX 1280
COACHELLA, CA 92236
(760)398-9222
Lic. No.: 656128
VOICE (760) 777-7012 "
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/21/08
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier SEABRIGHT Policy Number BB1080510
_ 1 certify that, in the ance of the wo for which this permit is issued, 1 shall not employ any
person in any m ner so to beco u ct to the workers' compensation laws of California,
and agree that, if I s t.to the workers' compensation provisions of Section
3700 of the Labor Code, I sh f with those provisions.
D e plicanT
WARNING: FAILURE TO SECURE OR S.
COMPENSA RAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMIN PENALTIES AND CIVIL FINES U `,DRED 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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this a7of
comes null and void if work is not commenced
within 180 days from date of issuanch pe71 it, or cessatio rk days will subject
permit to cancellation.//fy�I certify that I have read this application and state a in r do 'S rec agree to comply with all
city and county ordinances and state laws relatinging con he authorize representatives
of this cmy to enter upon the above-mentioned y for ' sp io
ate: Signa a (Applicant or Agent
s:
-Application Number .
. . . . 08-00001744
y
Permit .. . .
BLDG POOL PERMIT
Additional desc .
Permit Fee,
207.00 Plan Check
Fee
134.55
Issue Date . . . ..
Valuation
. . .
. 19680
Expiration Date
4/19/09
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
,162.00
Permit . . .
MECH POOL
Additional desc .
Permit Fee
26.00 Plan Check
Fee
6.50
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
4/19/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 11.0000
------------------------------------------------------=---------------------
EA MECH FURNACE >100K
11.00
Permit . . .
ELEC POOL PERMIT -RES
Additional desc .
Permit Fee . . . .
45.00 Plan Check
Fee
11.25
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
4/19/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1•.00 30.0000
--------------------------------------------------------
EA ELEC PRIVATE SWIMMING
POOL
-------------------
30.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
33.00 Plan Check
Fee
8.25
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
4/19/09
Qty Unit Charge
Per
Extension
BASE FEE"
15.00
2.00 6.0000
EA PLB FIXTURE
12.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000
----------------------------------------------------------------------------
EA PLB GAS PIPE 1-4 OUTLETS
3.00
Permit
WALL/FENCE PERMIT
LQPERMIT
LQPERMIT
Application Number ... . . . 08-00001744
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
320
Expiration Date 4/19/09
s
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
POOL/SPA, 20 L.F. 4' EQUIPMENT '
ENCLOSURE, CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION.
Fee summary Charged Paid
Credited
Due
Permit Fee Total 326.00
.00
00
326.00
Plan Check Total 160.55
.00
.00
160.55
Grand Total 486.55
.00
.00
486.55
. . t
'ALL DECKING EXPANSION JOINTS FOR
REPRESENTATION ONLY, FIELD LAYOUT
WILL VARY.
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— ------
II -
I� OWNER RES NBISILITIES
ENTRY OAKER
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0 f-0 AKEOCANDTTCE THATPODL AND ET111E TFr LOGTTOMMEo 119ECr TDACCBTAN`E OF
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WROTER PEIIN$SION OF TFSEIDU L9 FRONT® By UW.
O"M APPROVES RNL POOL AM EQLVAIENTLWAnOB AMIN91EA0 TERESPO Somm AroMnESABOVE
uR GUEST arxnT Lis) uTE
• -
SWIMMING POOL PLAN FDR:
® KOZOVSKI RESIDENCE
STREET- .-45 q
2- AR RAG ` PHONE 08 RE of Cm
-
LD CT PAGE BGGK
i
MAP BOOK PAGE NO. �y
_ ► _ CITY OF LA (/�J I. ADDRESS
- — �C U I p L T • CDNSTRUCTION GEEK PHONE NO.
I BUILDING & SAFETY ID\YEP�T� p
SCALE -1D� OV wNBY SI SOLD
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_.... .. ............._. —°— T
ss __aDDAAAQ¢g® I APPROVED JGBtl� � REVISIONS DATE:
.......- FOR CONSTRUCTION 1
I �
• I DAT DAa/F 2
BY � 3
5
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6 v
z
SELECTIONS w
CONSTRUCTION AUTHORIZATION STONE
SALES FIELD TIS W
DIG BOULDERS cr
PRE-GUNITE DECK COLOR �[
UNDERGROUND DANDY ?
MASONRY PEBBIPLAS 41?>tSL�, aC,4 ; DIJC� O
DECK SIGNATURE ON
PRE -PEBBLE DRAINAGE NOTE: D'�9Vo m0 MpBm fbr PtDtam as Pao byalhen Y
Bin #
City of. La Quetta
Building 8L Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta; CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1 -ILA
Project Address: 4'S y ,/7C
Owner's Name: SKI
A. P. Number:
Address: . ��✓ u G' f�
Legal Description:
City, ST, Zip: �-
Contractor: e
Telephon . �%� 53MOM
Address:b-- �".
Project Description:. L S
City, ST, Zip: /
Telephone: `-"Il:LZ
State Lie. # : 5 City Lic.
��
Arch., Engr., Designer:
Address: .
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:Fro�np�—'le
Construction Type: Raw, 4pw Occupancy:
Project type (circle one) ew Add'n Alter Repair Demo
Sq. FL: # Stories: # Units:
Telephone # of Contact Person: (760. v- UZ -9 1
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
D ILb
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person,
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees