04-4330 (RER)TA
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA.,QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
Property Address
APN:
Application description . . .
Property Zoning . . . . .
Application valuation . . .
Owner
------------------------
PGA WEST RESIDENTIAL ASSN. INC
54320 SOUTHERN HILLS
LA'QUINTA CA 92253
X04"=0-0004-3-3-0 Date 5/17/04
5419-0—RIVIERA;
775-031-043- - -
REMODEL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
8000
Contractor
OWNER
JUN 0 4 2004.
CITY OF LA
--------------------------
Structure Information. --- -------.--
Construction Type
. . ... . TYPE V'- NON RATED
Occupancy Type .
. . . . . DWELLG/LODGING/CONG <=10
Flood Zone . .
. . . . . NON -AO FLOOD ZONE
Other struct info
. . . . . CODE EDITION 2001
CBC
---------------------------------------------
. .
--------------------
. •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
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Special Notes and
-------------------------------------------
Comments
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VOLUNTARY SEISMIC
S.TRUCTURAL_REPAIRS.
Other Fees . . .
. . . . . STRONG MOTION (SMI)'- RES
.80
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other -Fee -Total
Grand Total
Charged
99.00
.00
.80
99.80
Paid •Credited Due
.00 .00 9.9.00
.00 .0.0 .00
.00 .00..' .80
.00 .00 99.80
P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: 4-.413 36
Applicant:
Applicant's Mailing Address:
chitecl
Architect or Engineer's Address:
Co S CC 9713a-ArG -
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ic. NO.:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: & - #
or Engineer:// yy��
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MUILUIN" I'LKMII DEGLARATIONS
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' I i
i
' ' I 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: 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 Profession`s 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
pplicant to a civil penaltyof not more than five hundred dollars ($500).):
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
WORKERS' COMPENSATION DECLARATION
I hereby affiym under penalty of perjury one of the following declarations:
have and will maintain a certificafe of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
Xof the work for which this permit is issued.
I have and will maintain workers' compensation in urance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation i ce carrier and otic( r]�m r re'
Carrier Gi it w wiY ^ olicy Number 1 4p"1 4 - ,a
/ _ I certify that, in the performance of the work for which this permit is issued, I shall not employ a person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I shou lecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions. I
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.
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
--r
ENT
IMPORTANT Application is hereby made to the Director of Buildingand Safety tyfor CKNOWLEDGEo the
tions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each peon atPermit
h s'e request and eforhose benefit work is Performed under or pursuant to an
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its
permit
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 the above information is correct. I agree t comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize repre entatives of this county to enter upon the ve-rn red property for insurposes.
/Bate � • Signature (Applicant or Agent)
&,