04-4349 (RER)rill
4
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
�`�OFTt�9 78-495 CALLE TAMPICO FAX (760) 777-7011
a LA QUIN,TA-, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number° . . X04=0-0004=3=4` ' Date 5/17/04
Propert;y..Address . . . . . 54790 RIVIERA
APN: - 775-031-034- - -
Application description REMODEL-- RESIDENTIAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation 8000
Owner Contracto
--------------------- --
PGA WEST RESIDENTIAL'ASSN. INC OWNER
54320 SOUTHERN HILLS lui
NTA
LA QUI NTA CA 92253
CITYANCE 4--
IFT.
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
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Permit BUILDING PERMIT
Additional desc
Permit Fee 99."00 Plan Check Fee .00
Issue Date . . . . Valuation 8000
.Qty Unit Charge Per Extension
BASE .FEE 45.06
6.00
9.0000 THOU -BLDG -..2',, 0017-25, 000 54.00
----------------=-------=---------------------------------------------------
Special Notes and Comments
VOLUNTARY SEISMIC STRUCTURAL,AEPAIAS
----------------------------
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
.00
.00
.00
.00
Due
99.00
.00
.80
99.80
P.O. Box 1504 �1��/; ,
78-495 CALLS TAMPICO w VOICE (760) 777-7012
LA QUINTA, CALIFORNIA 92253 44FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING &t: SAFETY DEPARTMENT
Application Number: c q - ,3�C] Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Gdvs*�+�>-�
Architect or Engineer's Ad res§,:.
CaSCo 9-m- CF-
S•i� (tib
ic. No.:
0IJ111-WINU F LKMIT 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
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 re'quires 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 orshe is iii ensed 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
tl� 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 stile 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 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
y issued. My workers' compensation ins!IL a carrier and policy number are:
lamer �3TF1:z!F-.J f� ceot cy Number / — OC 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
forthwith
comply with those provisions.
,---Date—!,,*, . -• o `I—�' 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.
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.).
Lenders Name
Lender's Address
IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT and Safety forACKNOWLEDGEMENT
to the
fions and
s set forth on this
1. Each person upon whose behalf this application is made, each person at whosee lrequest and for hlose benefit work isperformedunder or pursue t 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 Quinta, its
officers, agents and employeesfor 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 to comply with all city and county ordinances and state laws relafing to building
construction, and hereby authorize representatives of this county to enter upon the ab e -me •oned property for inspection purposes.
ate�t . y Ci'r ' nature (Applicant or Agent):
•
w.
DAVE .STEAVENS '.
Inspection ' Services
PROJECT
ADDRESS S4-19.0 12+ + c+Zt1
BLDG. PERMIT, # 'p LA- 4 3 `-!- q
ENGINEER��„�„�Jo�� Tic_
INSPECTION TYPE
PROJECT # UO S ► ' "i
CLIENT 0G P w t S r> (N
DATE ,�y PA2t L P00T.
ARCHITECT
CONTRACTOR4�7 cC- r+ C_. � w 5
INSPECTION REPORT
f`
FOLLOWING LOCATIONS EPDXY SIlVIPSON ETF. EXP. .11 -OS HOLES DEPTH CHECKED,.
BRUSHED AND CLEAN OF DEBRIS. APPLICATION. AND INSTALLATION.AS PER ICBO 4945
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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.
�j rintClearly) '
DATES -7P 2 V INSPECTOR SIGNATUP,F�:J2_