05-0470 (RER)79840 Arnold Palmer
' I IIIIIII VIII I I II I IIII 47 }
z
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 t> (760).777-7012
0g 4 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . 05000-00470 Date' 2/07/05
Property Address . . . . . . 79840 ARNOLD PALMER
APN: 775-241-077- - -
Application description . . . REMODEL - RESIDENTIAL
Property Zoning . . . . . .. . LOW DENSITY RESIDENTIAL
Application valuation . . . . 8000
Owner Contractor
-
----------------------- ------------------------
PGA WEST RESIDENTIAL HOA OWNER
54320 SOUTHERN HILLS
LA QUINTA CA 92253
_ ------ Structure Information VOLUNTARY SEISMIC RETROFIT -----
Construction Type . . . . . TYPE V - NON RATED
Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10
Other struct info . . . . . CODE EDITION 2001
--------------------7--------------------------7------------------------ - ---
Permit . . . . . BUILDING PERMIT
Additional desc
Permit Fee . . . . 99 . 00 Plan Check Fee , .
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
Phase 1 Fairways Units Voluntary Seismic
Retrofit . Voluntary seismic upgrade &
selected construction defect repairs
constructed to the 1985 UBC allowable
design values, applided. loads conform to
the 1997 UBC.
--------------------------------------------7-------------------------------
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
r FRe To
D 99 . 80 . 00 . 00 99 . 80
FEB 16 2005
CITY OF LA QUINTA
FINANCE DEPT.
P.O. BOX 1504 • �� VOICE (760)777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: OS" A+10 Date: • /.y
Applicant: Architect or Engineer:
Applicant's Mailing Address- Architect or Engineer's Address:
Y
Lic. No.:
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
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
the applicant to a civil penalty of not more than five hundred dollars($500).):
U I,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.).
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
ate Lit 1�°y� caner_
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'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued. My workers'compensation insurance carrier and policy number are:
CarrierF. Policy Number
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` ` ' .6 PPS IiCynt
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 Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made,each person at whose request and for whose benefit work is performed under or pursuant 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 of La Quinta,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 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 r resentatives of this county toe ter up n the above-mentioned property for inspection purposes.
Si/Signature(Applicant or Agent):
1111111114a
IE 4
P.O. BOX 1504
Building70"iZ4O fil'nOlQ r�1I�Or 78-105
Address LA QUINTA,CALIFORNIA 92253
Owner
wunrico Ccz_mpnny
Mailing
BUILDING: TYPE CONST. OCC.GRP.
Address 75-005 Counties' Club Drivo A.P. Number. MA Vnnt — 'x`M f niryirw-t
CityZip Tel.
Palm 0--ninirt 42260 l 56b—Mf3 Legal Description
Contractor w Project Description $+r"D' Plan FpAn
Lationn2. F.ortgago
Address
City Zip Tel.
State Lic. 288130 City
&Classif. Lic.# Sq. Ft. 2353 No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
7000)of Division 3 of the Business and Professions Code,and my license is in full force and
effect.
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation M M r�
I hereby affirm that I am exempt from the Contractor's License Law for the following 17 V 3/
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he Is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that.he is exempt therefrom, and the basis pian Chk. Dep.
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit p
subjects the applicant to a civil penalty of not more than live hundred dollars($500). U
O I,as owner of the property,or my employees with wages as their sole compensation,will
Plan Chk. BBI. j407.71)
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and 610.50
Professions Code: The Contractor's License Law does not apply to an owner or property who Const.
builds or improves thereon and who does such work himself or through his own employees. Mech. 31,+00
provided that such improvements are not intended or offered for sale. If, however, the building V
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical 97.01
of proving that he did not build or improve for the purpose or sale.)
O I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing It 14 Go
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.1. 11
~
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) «
Grading
O 1 am exempt under Sec. B.&P.C.for this reason
Driveway Enc.
Date owner Infrastructure tib 1
WORKERS'COMPENSATION DECLARATION L:CTt Yntrast.3m Cturo it Vic+7,:,
1 hereby affirm that I have a certificate of consent to self-insure, or a certificate of
Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.)
Policy No. Company
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL ` ,3
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation d 1.} +4t
or less.) - - --
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued.(Sec.3097,Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE IN PiECjOR
This is a building permit when properly tilled out,signed and validated,and is subject to ,$�PE i if
expiration If work thereunder is suspended for 180 days. /
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant Dale
Mailing Address Validation:
City, State, Zip
WHITE-FINANCE,PINK-APPLICANT,GREEN-BUILDING,GOLDENROD-ASSESSOR'S OFFICE,HARD COPY-FILE
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL SO Fl y $ - UNITS -
YARD SPKLR SYSTEM
2ND FL SO FT.a
POR SO FT.0 MOBILEHOME SVC. BAR SINK
GAR SO.FT.ft POWER OUTLET ROOF DRAINS
CARP. SO FT.6 DRAINAGE PIPING
WALL SO.FT.td DRINKING FOUNTAIN
SO.FT.
URINAL
(,I
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE Not to De used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHERIAUTOXDISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET
COMPRESSOR HP POLE,TEMIPERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SO.FT.®c BATH TUB
SO.FT.g c WATER HEATER
MAX.HEATER OUTPUT.B.T.U. SO.FT.RESID I4:c SEWAGE DISPOSAL
SO.FT.GAR r' 3/4c HOUSE SEWER
GAS PIPING
PERMIT FEE PERMIT FEE PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR
SETBACK GROUND PLUMBING UNDERGROUND A.C.UNIT COLL.AREA
SLAB GRADE ROUGH PLUMB BONDING HEATING(ROUGH) STORAGE TANK
FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE
FOUND.REINF. OUGH) METER LOOP HEATING(FINAL) OTHER APP.IEOUIP.
REINF.STEEL AS(FINAL) ,to TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMING FINAL INSP. $ plus x$ -$
ROOFING REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
ISH GRADING
L INSPECTION /O
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL