04-4161 (RER)3 � •
BUILDING & SAFETY DEPARTMENT
c w4 P.O. Box 1504 (760).777-7012
° • �hrOF fc.9 78-495. C.ALLE TAMPICO FAX (760)777-701 1
LA QUINTA, CALIFOkNIA 92253. INSPECTION REQUESTS (760) 777-7153
BUILDING PIERMIT
Application Number . . . . .04-000.04-1.61_ Date 5/13/0,4
Property Address 79785 OLYMPIA FIELDS
APN: 775-152-045- - -
Application description REMODEL - RESIDENTIAL
Property Zoning.. LOW DENSITY RESIDEN
Application valuation . . . . 1500 u `
Owner. Contractor MAY 19 2004 r�
PGA WEST OWNER clr1 OF1.AQU; IUA
54320 SOUTHERN HILLS FINANCE VE".
LA_QUINTA CA .92253
-------------------------------------- Structure Information --.
Construction Type . . TYPE V - NON -RATED
Occupancy Type DWELLG/LODGING/LONG <=1,0
Flood Zone NON=AO FLOOD ZONE
Other struct info . . . CODE EDITION 2001 CBC
Permit BUILDING PERMIT
Additional desc
Permit Fee 35.00 Plan.Check Fee .. .00
Issue Date Valuation 1500
Qty Unit -Charge Per Extension
BASE .FEE 15.00.
10.00• 2.0000 HND BLDG 5'01-2,000 20.00
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 .00 .00
Other Fee Total .50 .00 00 ;*` .50_
Grand -Total '35.50 .00 .00 35.50
y
C&f 4 4
P.O. BOX 1504 "
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Applicant:
Hppncanrs mailing Address:
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: (�( 64—
-Architect or Engineer:
'
Architect �Engineer sILA—
A dress:�
c. 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
tJQe 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 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 DECLARATKN
: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.
,KI 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. M workers coprn ensatio�irance carrier and policy num r
rtier. �j j�47I LW `J P� olicy Number. l � 9 S21 X—( J
_ 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, 1 shall
forthwith comply with those provi 'ons.
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WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND LL ES AND
SHASUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST HA COMPENSATION, DAMAGES AS PROVIDED FOR TI
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.IN
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
Lenders Address
APPLICANT
IMPORTANT Application is hereby made to the Director of Buildin and SaACKNOWLEDGEMENT
o A
1. Each person upon whose behalf this application is made, each person at whose request and for hose benefit works
rk permit subject to the conditions and restrictions
under or pursuant to any perm
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless permit. the City of La Ouinta, its 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
cessafion 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 noes and state laws relating to building
cons7,Aonna hereby authorize representatives of this county to enter upon e a ntioned p rty for ins n pu ses.
Date S' ature (Applicant or A ent :
.,r—�P. � _•rwr.rnsrwar. �f., ''k +, �r .tl .w'.`.P�".�u'��.++rf4iro.+w.w.� v T
Ap
Page / of
DAVE STEAVENS
Inspection Services
PROJECT C I?e,. O c, PROJECT # cpoo-16y6
ADDRESS"' C - 'II)
BLDG. PERMIT # --
ENGINEER O « , J
INSPECTION TYPE
CLIENT -P 6 A (-J-6-0 H00',
DATE --2 q '? u r3 ( 0 V `°E
ARCHITECT 2 ��
CONTRACTOR.
INSPECTION REPORT
FOLLOWING LOCATIONS EPDXY SIMPSON ETF. EXP. 7 -OT 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
1. (Print Clearly)
DATE +-•�"' �%' � Ufa 4INSPECTORSIGNATUP,E � +`ster' C... .-/,1. a �..�
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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
1. (Print Clearly)
DATE +-•�"' �%' � Ufa 4INSPECTORSIGNATUP,E � +`ster' C... .-/,1. a �..�