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05-1252 (RPL)TWIf f�ftrw BUILDING &" SAFETY DEPARTMENT P.O. Box 1504 (7.60) 777-7012 495 CALLS TAMPICo FAX (760)777-70.11 D QUINTA, CALIFORNIA 922,153 INSPECTION REQUESTS (760) 777-7153 APR 112005 BUILDING PERMIT, 1 C11'Y OF 4A QUINTA so Pt. umber ` . 050,0-0-0T2-52, Date 4/04/05 Property Address_.. 78890 SUNBROOK LN APN: 604-291-011-11 -23995 - Application des`cr+ption POOL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation 2350'0' Owner Contractor THOMAS MC CALLUM POOLS ! 78-890 SUNBRQOK, 46576 VIA CELESTE, LA QUINTA CA 92253 'INDIO CA 92201 -(76.0)" 775-5685 WCC: EXEMPT WC: EXEMPT 05/31/05. CSLB: 818835 04/30/0.5 CCC C53 ., . Permit BLDG POOL PERMIT Additional desc Permit Fee 243.:00 Plan Check Fee 157.95 Issue Date Valuation . . . . 23.5"00 Qty, Unit Charge Per Extension 'BASE FEE. 45.00 22.00 9.0000 THOU BLDG 2,001-25,000 198.00 -------------------------:--- Permit MECH POOL Additional desc Permit Fee 24.00 Plan -Check Fee 6.00 Issue Date < Valuation 0 Qty" Unit"Charge Per Extension" BASE FEE 15.00 1.00 9.0000'EA MECH FURNACE <=100K 9.00 Permit ELEC POOL PERMIT -RES Additional desc Permit Fee• . . . 45.00 Plan Check Fee -11.25 Issue Date Valuation 0 Qt -y 'Unit Charge Per Extension BASE FEE 15.00 1.00 30.0000 EA ELEC P"RIVATE SWIMMING POOL 30.00 Permit" . . . . PLUMBING Additional desc.: Permit Fee . . . . 33.00 Plan Check Fee 8.25 P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 'G�� LA QUINTA, CALIFORNIA 92253 4 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: OJT ` . S,2 Date: Applicant: I Architect or Engineer: . Applicant's Mailing Address: (ZO�JTi A GTO 2 Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions o Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and License isjn ( force and effect. � I o� cense Class `'� License No. O C ,P41 -e-1 • I I M Contractor 1� �Lf"1 11 K H. r—? O d' ( 1 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the -following reason (Sec. 7031.5, Business and Professions Code: ,kny 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 sig ezd statement that he or she is licensed pursuant to the provisions of the Contractors' 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 or 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.). U 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.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' COMPENSATION DECLARATION 'I hereby affirm under penalty of perjury one of the following declarations: 1 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 d policy number are: Amer Policy Number _ 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, and agree tha if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall / forthwith comply w' visions. p* ''i - I ( '0 �_ Applican WARNING: FAILURE TO SECURE WO KERS' CO SATION COV =RAGE WFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THO LLARS ($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. 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 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Euilding and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application :s 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 Ouinta, its officers, agents and employees for any act or orassion related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the a ation is rr ct. I agree to comply with all city a unty ordinances and state laws relating to building construction, and hereby authorize representatives of this ounty o ente po the bove-mentioned perty for ins ctio purposes. D to Signature (Applicant or Agent): V L Page2 Application Number 05-00001252 Date 4/04/•05 Issue Date Valuation 0 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 Special Notes and.Comments _ POOL & SPA. ALARMS/BARRIERS SHALL BE IN .: PLACE PRIOR TO PRE-PLASTER"INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED IN �. PERMIT. Fee summary Charged Paid Credited Due ----------------- Permit Fee -----------------------;------- Total*. .345.00 .00 ..00 ---------•- ,.'3,,4,5.00. Plan Check Total,, 183.145 ;00 .00 183.45 'Grand Total 528.45 .00 .00 528.45 CITY OF LA QUINTA SUB -CONTRACTOR LIST 0y-' 441- JOB ADDRESS PERMIT NUMBER OWNER BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in'a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response: Classification Trade Clas Contractor is e State:::Contractot s. License . Workeis.Com ensatioiiarisurance:" : ` : City.. Business License: Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exr. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date' (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) Q 3- 3 1 -L S � ---P 1 9 ©0a- x-147 - -6 C� �% CONCRETE (C -8),:L c7 s 81 �a o o y. -. I - c� ti as �' �- vs FRAMING - STRUCT..STEEL (C 51) ff YC I S,S 6 S ,� C-7 y' / V 1 MASONRY 1C-29) PLUMBING (C-36)' S O .L�S G 3' 3 Q S�cn e .,- cl 7r aC �{ LATH; PLASTER (C-35) n x e S b" 31 'Q DRYWALL (C-9) .:. HVAC 1C-20)` >".: = ELECTRICAL. (C-10) a7 2 �Q O U 3 S S O 3- U _1 u i -e �n V 00 �4 -► �3 I% ROOFING.IC.-391:;- SHEET METAL (C43),-'.':.' FLOORING GLAZING (C-17):` INSULATION `(C-2) . i SEWAGE DISP; (C-42) PAINTING IC -'3j) CERAMIC TILE (C-54) CABINETS (C-6) FENCING (C-13) ` LANDSCAPING (C=27) POOL (C -53)C ��� ).i�/•CSS L C