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04-4329 (RER)`"F�WQ�rw P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (76.0).777-7012 FAX (760) 777-17011 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number k04;OA.004329 Date. 5/17/04 Property Address . . . . . 54160 RIVIERA APN: 775-031-044- - Application description . . . REMODEL - RESIDENTIAL Property Zoning . . LOW DENSITY RESIDENTIAL Application valuation . . . . 8000 WL�A Owner Contract PGA WEST RESIDENTIAL ASSN. INC OWNER54320 SOUTHERN HILLS -LA QUINTA. CA 92253 Structure Information Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . CODE EDITION 2001'CBC = ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee 99.00 Plan"Check Fee .00 Issue Date . . . . Valuation . . . 8000 Qty Unit Charge Per Extension BASE FEE 45.00 6.00 9.0000 THOU BLDG -2,001'_25,000 54.00 ------------------------------- Notes and Comments. VOLUNTARY SEISMIC STRUCTURAL REPAIRS q Other Fees . . . . . . . . . STRONG MOTION (SMI) - RES .80 Fee summary Charged Paid Permit Fee Total 99:00 ..00 Plan Check Total .00 .00 Other -Fee -Total 80 .00 Grand Total 99.80 .00 Credited Due .00 99.00 .00 .00 .00, .80 .00 99.80 P.O. BOX 1504 ���� VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 4 4 78-495 CALLS IFORNO FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: - Date: Applicant:Itect or Engineer: abt .g & a Lt— Applicant's Mailing Address: Architect or Engineer's AdeqiK� C4P No. C I C, MUILUING PERMIT DECLARATIONS 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 the Business and Professionals Code, and my License is in full force and effect. License Class License No. Date Contractor 1. OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' 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 Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) of 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 tPVapplicant 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 sdle 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 or 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_ /1 WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificaie 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 nu r are ,Gamer 4'i14`i� f^r4Aj_<> umber l Sa 9 9 4- _ I certify that, in the performance 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 that, if I should come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. / Date (p T. 9 ( Applicant 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. LENDING ENCY I hereby affirm under penalty of perjury that there is a construction lending age cy or�the performance of he work for which his permit is issued (Sec. 3097, Civ. C.). Lender's Name Lenders Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safety or a ty permit subject to he 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 Ouinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of his 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 above information is correct. I a e to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ent upon bov ntioned properttAW4XSeDction purposes. Signature (Applicant or Agent):