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04-4333 (RER)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 + F Application Number Property Address, APN: Application description Property Zoning Application valuation . Owner ------------------------ PGA WEST RESIDENTIAL ASSN. INC 54320 SOUTHERN HILLS - LA QUINTA CA 92253 -0 4---0 0 0 0 43 3-3 Date 5/17/04 54280 RIVIERA 775-031-058- - - REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 8000 Contractor ------------------------ OWNER D e Fee. summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 99.00 .00 JUN 0 4�0_ ---------- Structure Information ------ .00 Construction Type . . . . TYPE V - NON RATED CITY OF LAquINTA Occupancy Type . . . . . . DWELLG/LODGING/LONG <=1 FINANCE DEPT. 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 --------------------------------------------- Special Notes and Comments VOLUNTARY SEISMIC STRUCTURAL''` REPAIRS^`•, Other Fees . . . . . . . . . STRONG MOTION (SMI) - RES .80 Fee. summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 99.00 .00 .00 .00 .80 .00 99.80 .00 Credited Due .00 99.00 .00 .00 .00 .80 .00 99.80 P.O. BOX 1504 44" VOICE (760) 777-7012 LA QUINTA, CALIFORNIAFORN92253 78-495 CALLE O FAX (760) 777-7011 INSPECTIONS (760) 777.7153 BUILDING & SAFETY DEPARTMENT Application Number: USI - 4f-::�.57 Date: Applicant: Architect or Engineer: CSG Le - A- / - Applicant's Mailing Address: Architect or Engineer's Atldres r o S la i��-- �� o.: BUILDING 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 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 I i 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) 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 applicant to a civil penalty of not more than five hundred dollars ($500).): 1, 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 i himself or herself 6r 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 PP.Cj�for this reasons A ate WORKERS' COMPENSATION DECLARATION I hereby gl5rm 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. 1 have and will maintain workers' compensatio insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatio ' rance carrier and policy number a Cartier �'11R-r�' ,^. � Policy Number j SD 4 S 9 gE � 3 _ 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 that, if I shoul become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall � forthwithcomplywith those provisions. . PPIiI� cant 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 ENT IMPORTANT Application is hereby made to'the Director of Buildingand Safety tyfor CKNOWLEDGEo the ic bon. 1. Each person upon whose behalf this application is made, each person at whose request and for Mose benefit wtriork istions and res performedunder or pus set forth on this lrsuant 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 u su lit to ,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 2nd state that the above information is correct. I agree to 99inply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon thea ov nti ropeRy for inspection purposes. ate Signature (Applicant or Agent):