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04-4353 (RER)Titf.44QaA& 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 0_0004353 \ Date 5/17/04 54730 RIVIERA 775-031-036- - REMODEL RESIDENTIAL. LOW DENSITY RESIDENTIAL. 8600 Contractor"' e OWNER ,;uo 0 41004 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 Permit . . . . BUILDING.PERMIT:. Additional desc .t Permit Fee . . . . 99:00 Plan Check Fee'. .00 Issue Date . . . . Valuation . . 8000 Expiration Date . . 11/17/04 Qty Unit Charge Per ,.,Extension d BASE FEE 45.0.0 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. Charged Permit Fee Total 99.00 Plan Check Total .00 Other Fee Total .80 Grand Total 99.80 Paid Credited ---------- .00 . 00 . . 00 . 00 ` .00 .00 .00 .00 Due 99.00 .00 .80 9,9 . 8 0 P.O. Box 1504 78-495 CALLS TAMPICO � {� � VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 014, L�,3,5 3 I Date: (V' Applicant: Applicant's Mailing Address: -Architect or En ineer: hl 64 " - Architect or Engineer's Address: b 4�7l o S7 C1� -gait) I C 1 e4' 77- 8 uUtLu11YV 1-MKmII UtGLAMAIIONS 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 ' `i Contractor I IOWNER-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 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).): 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 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 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' compensa 'on insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensate urance carrier and otic number are: Carrier cY1Y}ii.= �J w1t� Policy Number L�Ar�— QQ �xa0 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 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthhwiitth� comply with those provisions. -.,Date_U -Xpp—Iii cant >J 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 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safety fo a os set forth on this appic bon. 1. Each perscn upon whose behalf this application is made, each person atwhosle requ st and fto theor whose benefi work sbictinperformed under or pulrsuant to any permit 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 Ouinta, its officers, agents and employees for any actor omission related to the work being performed under or following issuance of this it. 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. 1 certify that 1 have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to a ter upon the a ve n ' ned property for inspection purposes. /bateSigma nature (Applicant or Agent): p` fir. Page i of t DACE STEAVENS Inspection Services. PROJECT QCT PROJECT .# ADDRESS .TL( -13o- CLIENT ,�)& N c& S T- C DATE (�d KP Itl L. a o BLDG. PERMIT # 04- q 3.� -3 ARCHITECT G v 3 f\IZC ENGINEER �u;�� Sfl•uo-C_ CONTRACTOR -6 -,ca INSPECTION TYPE INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SRAPSON'ETE EXP. 11-o;5: Io -o'er HOLES DEPTH CHECKED,.... BRUSHED AND CLEAN OF DEBRIS. APPLICATION' AND INSTALLATION AS PER"ICBG 4945 qf"(- -•oZ COOS - b-'�UIcS- 11I -z l��P-T -6.o" 1ZDOS-�v iL l_c►J�:�1 B Jtfa LQ LI') Lr_5 TH 1 a LG C S - o L-IC5 1 '� Lt; ►� tn� -i i� is �►j1 ��wt.� Com- �`l-\ST �cJ.Ca 6 �0L-001,O `�� Civ-�TL1�C— fi4i,V_b,- t�a� ,_►�-zU*_% .f%7, a �F 1 , (� , �.._ A � D F��`'1 '�A t L t �7 L �,O t� � L.y L Z- .. •' y - LL_ uTC Z\ o r L #,03) t-ti:7r_sL.w Z �D; U _S y--lfaRb2'c AJC 0 . S(rlEii(Z AtwJb'`��-�`' U -,;I 2u i,J A W -k u.. AJC l wl Le - Co CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, substantially complies with -approved plans, specifications and applicable.sections of the building. codes. This report covers the locations of the work inspected only and does not constitute engineering,opinion or project control: ' CERT. NO. 0859348-50.. -INSPECTOR NAME DAVE STEAVENS DATE J �✓ P—r 2.pO INSPECTOR SIGNATUPE