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04-4163 (RER)Td tGfti BUILDING & SAFETY DEPARTMENT P.O. Box 1504 ' (7.60).777-7012 78-495 CALLE TAMPICo FAX (760) 777-7011. LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-71.53.. BUILDING PERMIT Application Number . . . . . Q-47_-=:0.0004'16`3' Date 5/13/04 Property Address, 79797 OLY A FIELDS• APN: 775-152-047- - - Application description.. REMODEL- RESIDENTIAL Property Zoning . . . LOW DENSITY RESIDENTIAL Application valuation 1500 n Owner Contractor -- - - - - - - - - - - - - - - -- -- Ar PGA N ------ ----------- -- A4/ 204 PGA WEST OWNER 54320 SOUTHERN HILLS CITY CSFLAOWNTA LA QUI NTA CA. 92253 FINANCE DEPT. 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 Permit . . . . BUILDING PERMIT Additional des.c ` . Permit• -.Fee 35.00 Plan Check Fee .00 Issue Date Valuation . . 1500 Qty Unit 'Charge .Per Extension BASE FEE 15.00 00--_-_20000 HND BLDG 501-2,000 20.00 -__-__-10----------- --- Special Notes and.Comments VOLUNTARY SEISMIC STRUCTURAL REPAIRS Other Fees . . . .. STRONG MOTION (SMI) -RES .50 Fee summary Charged Paid Credited Due Permit Fee Total 35.00 .00 .00 35.00 Plan Check Total .00 .00 .CSO .00 Other Fee Total, .50 .'00 CIO 50 Grand Total 35.50 .00 C-0 35.50 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: Date: J ICL 104 Applicant: hitect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: U,5 Lo BUILDING PERMIT DECLARATIONS v 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 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 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 purposeof 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 contras o de licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason_ WORKERS' COMPENSATION DECLARATtdN ,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 n polic,1(n ber re: Carrier �5`t,E%�� —'—tom ,\ FD Policy Number 790 `7�q� —Q--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 6 pplicant 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, indemnity and hold harmless the City of La Ouinta, its officers, agents and employeesfor any act or omission related to the work being perforned 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 ordinance - of to laws relating to building constructio and hereby authorize representatives of this county to enter upon th abov mentioned property for inspection purposes. ` r Date �� Si ature (Applicant or Agent): V t: t` Page of DAVE STEAVENS Inspection Services PROJECT / G, } td j-"5?" - PROJECT # .2 oo ADDRESS`JCj-'`i4'•`! CLIENT 6,d L,JJ..S (e A r:7, DATE "f3 --LLT , J E BLDG. PERMIT # (` ARCHITECT r` A ,? c �f ENGINEER T, ,c of CONTRACTOR PrtL f F:G INSPECTION TYPE INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SUVIPSON ETF. EXP. "7 - HOLES DEPTH CHECKED, BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945 Z Y" . r -_3.J1 iLam! -' t- oG�j hi �'� =. 4ca' ji U ?T�fl I t\. G+ #� �; - I F L r r ! Gy i tr1 tj a7 It) 41:) - � c. ^ � � �3 C c S ` �� : ,`"rt-� �r � �,�, • � u t'��' � �'y L,.f �G 'i �i �J � t+Z . �7 -.'7 A Lt- iz C r, I, -N SIF r ri r) � .` �' ir; r� ►+�,,..) t , P.4 a r> W-0k%'L'e �� 4 t l . a i l �i � " ()1-)'r1 C - LL 4 ( ' � ®'- i�'� �• � ( L.tJ iF\ L. -,L..__ � � ( l.. a , � C., " `�,:. c� , v^..� L. �.. i' c: 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 ,� (Pri;a Clearly DATE � 3 / INSPECTOR SIGNATURE +-C, / t