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04-4350 (RER)fi T-Vf 4 4 Q" BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-70.12 78-495 CALLE TAMPICO `\ FAX (760) 777-7011 LA. QutNTn, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number'-`. Property Address . . APN: Z Application description . . ,.Property Zoning'. Application valuation Owner ------------------------ PGA WEST RESIDENTIAL ASSN. INC 54320 SOUTHERN HILLS LA QUINTA CA 92253 04-000043_ -0) Date 5/17/04 54820 RIVIERA 775-031-033- - - REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 8000 Contractor F OWNER N 04 2004 -------------------- - - - - -- Structure Information I CI Type NNCPIAAET.Construction TYPE 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 ----------------------------------------------------------------------------- Special Notes and Comments. VOLUNTARY SEISMIC STRUCTURAL REPAIRS` Other Fees . . . . . . . STRONG MOTION (SMI) - RES .80 Fee summary Charged Paid Credited Due Permit Fee Total 99.00 .00 .00 99.00 Plan Check Total .00. .00 ..00 .00 Other Fee.Total .80 .'00 .00 .80 Grand Total 99.80 .00 .00 99.80 P.O. Box 1504 �� 78-495 CALLS TAMPICO f� VOICE (760) 777-7012 LA FAX (760) 777-7011 QUINTA, CALIFORNIA 92253 4 4 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: (o - -0 Applicant: chitect or Engineer - Applicant's Mailing Address: Architect or Engineer's Address: Q m- A.t7-= No.: Iq j2 19 tsUILUINU 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 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 lie 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 �,��,pplicant to a'civil;penalty of not more than five hundred dollars ($500).): , , as owner of tlie',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 Professidns 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. . B.& 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 Kof 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. I�Lworkers' compensation i nce carrier and policy num r are: crier Ci �"R (2— IZt �� -Policy Number ___ (!j p 9� 41 - — t _ 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 T ppli� cent WARNING: FAILURE TO SECURE WORKERS' OMPENSATION 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 APPLICANT IMPORTANT Application is hereby made to the Director of Buildin and Sa ett for CKNOWLEDGEt Subject o the 1.. Each person. upon whose behalf this application is made, each person at wh sIe request and for hose benefit work stions andnperformed under or puset forth on thislrsuant 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 puinteits , 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 to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above n ned propert for inspection purposes. r V Sig— nature (Applicant or Agent): �. Page of ..DAVE: STEAVENS Irispectioo Services PROJECT �C- l,c�tS - GAu cad(.= 5 PROJECT # ADDRESS j y - e ao R1 1 1 ca-ft� CLIENT Q/ WEST . H & DATE 1''. 2 k t, BLDG. PERMIT # - ARCHITECT 6,4>c_3 A fiftLUl ENGINEER �� cJy o i fCONTRACTOR,\ C- k� C' - INSPECTION INSPECTION TYPE INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SUAPSON ETF. EXP. • k\-02-- HOLES DEPTH CHECKED, BRUSHED AND CLEAN OF DEBRIS. APPLICATION, AND INSTALLATION AS PER ICBO 4945 - xT 3 :q -;i5 �UzN ��-T t,J,a,i,�S-. ZArni�l� NA2��JA2e-T�JSL,L-A U— HZA K) A ► L, .J rfl - o. rA CL m 2 L. T 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 _0 the locations of the work inspected only and does not constitute engineering opinion or project control. • CERT. NO. 0859348-50 INSPECTOR NAME . DAVE STEAVENS (Prig . learly DATE S CP INSPECTOR SIGNATUP,F_ �\ C�, ._vim n .�