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05-4686 (RPL)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property. Address: APN: Application description: Property Zoning: Application valuation: Applicant: 0b=_00004-6862 81153 DESERT SAGE CT 764-270-999-146 -300239 POOL - RESIDENTIAL MEDIUM HIGH DENSITY REE 30500 Architect or 1 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ----------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of thegus and Professionals Code, and my License is in full force and effect. License Class: License No.: ate: •r) Contract r: C OWNER-8UILDE ECLARATIO ' I hereby affirm under penalty of perjury that I am 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).: (_) 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.). (_ 1 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 contractorls) licensed pursuant to the Contractors' State License Law.). 1 1 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: JORSKI BRETT 81153 DESERT SAGE LA QUINTA, CA 92253 Contractor: MC CALLUM POOLS WCC: EXEMPT WC: EXEMPT CSLB: 818835 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 05/31/06 04/30/07 Date: 10/20/05 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I 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 C53 Policy Number - - - - - - - - - - - - - - - certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any m ne as tobecome subject to the workers' compensation laws of California, and agree that, i I shout Uecomebject tothe workers' compensation provisions of Section 37000 of the Labo Code, Iwith comply with those provisions. Dat ��l'Y Applicant WARNING: FAILURE TO SE RE WORKERS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO INAL PE LTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITIO HE 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 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 ove information is correct. I agree to com'''�pll���y with all city and county ordinances and state laws relating t wilding c truction, and hereby authoriIrepratives of thiscounty to enter upon the above-mentioned pr erty for insp ctio purposes. OatLr: L Q 7 d�Signature (Applicant or Age. - Application Number . . . . . 05-00004686 Permit . . . BLDG POOL PERMIT INV FEE Additional desc . Permit Fee . . . . 582.00 Plan Check Fee 189.15 Issue Date . . Valuation 30500 Expiration Date 4/18/06 Qty Unit Charge Per. Extension BASE FEE 504.00 6.00 13.0000 ---------------------------------------------------------------------------- THOU BLDG 25,001-50,000 78.00 Permit . . . MECH POOL Additional desc . Permit Fee 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation 0 . Expiration Date 4/16/06 . 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 4/16/06 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 4/16/06 , 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 ONLY. ALARMS/BARRIERS SHALL LQPERMIT Application Number . . . . . 05-00004686 ---------------------=------------------------------------------------------ Special Notes and Comments BE IN PLACE PRIOR TO PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT ' INCLUDED IN PERMIT. INVESTIGATION FEE ASSEESSED PER 1997 UNIFORM ADMINISTRATIVE CODE $304.5 FOR WORK BEGUN WITHOUT BUILDING PERMIT. Fee summary Charged Paid Credited -------------------- Due ------------------------------------- Permit Fee Total 686.00 .00 .00 686.00' Plan Check Total 215.15 .00 .00 215.15 Grand -Total. 901.15 .00 .00 901.15 LQPERMIT ' OOL EQUIPMENT FTH� /BLIND WALL STUCCO O MATCH EXISTING +18" RAISED SPA W/STAKED STONE SPILLWAY STONE FINISH ON OUTSIDE OF SPA S STONE QUARTZITE WATERLINE 5'-O" POOL PEBBLE FINISH STAMPED DECKIN NNING. SHELF "•' -�,A;UMB ECA SL -EVE BLIND WALL TEPS o NOIlonblISN00 803 03AOHddV '1d3O An:AVS V ONimine VINino v-1 ziO Ain GAS STUB OUT FOR FUTURE OUT DOOR FIREPLACE CUSTOM 880 QUARTZITE STONE FINISH 30" STAILESS 880 W/STAINLESS STEEL DOUBLE DOORS,UMBRELLA SLEEVE •& ELECTRICAL GFI OUTLET W/+42" SITTINi AREA, FLEX LIGHT AND ICE/PREP AREA -STOOLS PROVIDED BY H.O. CITY OF LA aUINTA $U-B-CONTFLACTOR LIST JOB ADDRESS J 3 12 6SVQI S'� PERMIT NUMBER 0 S' %&OWNER /Weer X09!9k-L gUILpI:R MC 0,A 4. This form shall be posted n the job with the Building InsRe -tio afd at all times in a consRicious 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* Inform ation requested below must be completed byapplicant. "On File" is not an acceptable response. Trade ! Classification."Contraetor < : x�' :; ; State. �o�rtrectol's'L(eenati Workeib Com 6neetion l�eurance. Cit Bus?nabs License:'..: Company Name Classifkation License Number Exp. Data Carrier Name Poiioy Number (e.g'. A. 8. C-8) (xxx)lxx) lxx/xxlxx) (e.g. State Fund, CalCo/ip) (Format Varies) Exp. Date (xx/xxlxx) License Number Exp. Data (xxxx) (xxixxlxx) EARTHWORK (C-12) S' dG 01 - �U 3 • ob 4,, -•t~ -'�, 2 Z c, 'I%- I. Tt LfVx5atoe3GONCR .Q . 1 . b FRAMING W-61 - O STTiUCj:.STE1<L• (C.St l i_ c l % B O� o c.-% J" / pp 06 l I5 1 • A80NRY (C•2B1 P. .MBMO' (C-3WP, 03 JJ ad I •oto (0 7J �. • cc LATH,.PLASTER(C•3S) S Cj CI? w 0 J' Z / Nk DRYWALL IC-91 100) 0,L IN HVA(; (C-20) ELECTRICAL. tl:l114 eo si C. I S '� I O. b �j j t~ (Q (4-1-0 LL/ -L 6 6-7 100FING AHE 9T MIETAL (C-43) FtoORIN41C=161: OLAZIFIG 10171, �° ' WSULATIOWfC41 SEWAGE pISP: (0.42) ' PAINTING (C43) CERAMIC TILE (C-64) CABINETS IC-61 - FENCING (C-13) I euncre°wn Ir_.171 . . Bin# City ,of La Quinta Building and Safety Division P.O. Box 1504 78-495 Calle Tampico La Quinta, CA 92253 Building Permit and Application Tracking Sheet Permit# Project Address: 81-153 DESERT SAGE CT. Owners Name: .BRETT JORSKI A. P. Number: Address: 81-153 DESERT SAGE Legal Description: Ci , ST, Zip: La Quinta, CA 92253 Contractor: MCCALLUM POOLS Telephone: Address: 46-576 VIA CELESTE Project Description: City, ST., Zip: INDIO, CA 92201 Pool and Spa Telephone: 775-5685 State Lic. # 818835 City Lic.# Arch., En , Designer: Address: City, ST. Zip: Construction T Oecu an : Project T : New Add'n Alter R air Demo [Tele n: JOE Sq. 'ft. #Stories: # Units:Contact: Estimated Value: $30,500.00 re, e ^C. (\qfG' T'd S89GSLL09L wnjjejoW ydasor e9T:TT SO LT '400 (o 0, f CITY OF LA QUINTA SUB -CONTRACTOR LIST MC L�E/,lti ll� JOB ADDRESS �� 3 ' 06$ R j SA— iMPERMIT NUMBER D S' ��p OWNER DSC- � .�OIZ SIC, / BUILDER This form shall be posted on the job with the Building Insnection C@rdat all times in a consnicilous 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, alf information requested below must be completed by applicant. "On File" Is not an acceptable response. Trade J Classification Contractor ' "'` •:; a%":;':' ^%S.tete:<Controctor's rlcona4 . '. ;, r Workarb Com trnisetlob•Insurance. t3it Bustrte8a License':`..: Company Name classification (e.g.A. B, C-81 License Number (xxxxxxl Exp. Date 4xx/xx/xx) Carrier Name (e.g. State Fund,�lCaiCorop) Policy Number (Format Varies) Exp. Date' lxx/xx/xx) Llceme Number 4xxxx) Exp. Date (xxlxx/xx) EARTHWORK (C•12) S' d� 03 So 3 •06 •44� ice, nG Z 4 �1 1, o(, ,jl % cq, ONcgTE 1C-8) © P b-3U•O O , • 1 - le 4225 FRAMINQ'IC-6F •'• t) STRUCT:.STEj G (C.51) ) L 7`r c % %lc C d� o-{ / tJ0 06 l j I • Ci. ASONRY I.C•291 P. .MBING (C•361 O3 JJa D l -O to )� S <�� •cam( LATH, PLATER (C•35)5. • CS CI U w 8 t)' 'toL T2 Z ., DRYWALL C•9) too (D �iV fOi3r cb 6/� HVAC (0-20) •'' ELECTRICAL.(C-101 ' C. I SSS 3 1 0 b S j-� �,"c� C� -1 -0 l�•/ -�` 6" (67 ROOFING (Ot331`;,V.`s'. .SHE 2) '. FLOORING IC=94sl: ,; ••. `` GI:A2ING 10171, ' INStJLATIOM.(C-21 - SEWA13E p!SP: 10-42) ' PAINTING (G33) CERAMIC TILE (C-541 CABINETS IC -61 FENCING IC -13) LANDSCAPING (C•27) POOL (C•53) C N , �C t J S