04-4166 (RER)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO, FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 7.77-7:53
BUILDING PERMIT
Application Number
Property Address
APN:
Application description . . .
Property Zoning . . . . .
Application valuation .
04 - 00004.1.6.6 Date
54949 TANGLEWOOD
775-152-050- -
REMODEL - RESIDENTIAL
LOW DENSITY TIAL
1500 11
5/13!04
Owner Contractor I
------------------------------------19?s04
PGA WEST /-/44 OWNER
54320 SOUTHERN HILLS CITY OFLAOUNITA
LA QUINTA CA 92253 FINANCE DEPT
Structure Information
Construction Type
. . . . . TYPE,V - NON RATED
Occupancy Type
DWELLG/LODGING/CONE <=10
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
. . .
. =500
Qty ,.Unit Charge Per
Extension
BASE FEE
15.00
10.00 2.0000 HND BLDG 501-2,000
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
C.O .00
.00
.00
Other Fee Total
50. .'00
.00.
.50
Grand Total
35.50 .00
.00
.35.50
! y
P.O. Box 1504
Y VOICE (760) 777-7012
78-495 CALLS TAMPICO
LA Qu1NTA, CALIFORNIA 92253 FAX (760) 777-701 IINSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: rj
Applicant:
Applicant's Mailing Address:
BUILDING P
Date: _� (' 0
-kchitect or E59ineer:&-fLd
(->(x V 4
Architect or Engineer'sdres�
,�,f
2^1
067 -NO.: (_l9
IT 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 fora permit subjects
►tl)¢ applicant to a civil penalty of not more than five hundred dollars ($500).):
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.dor this reason
Date4� Owner
WORKERS' COMPENSATION DECLARATION
'.I hereb,4ffrm 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 'surance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
��isd. My worked' compensatio ance carrier nd poligy�r umber are:
er �/h l TJ 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, 1 shall
forthwith comply with those provisions. /1 _
Date � � scant .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BJECT 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 IIFA
ENT
IMPORTANT Application is hereby made to the Director of Building and Safety /APPLICANT
CKNOWLEDGEt subject o the
1. Each person upon whose behalf this application is made, each person at wehosle request and for conditions
ose benefiwork isperformedunder or pus set forth on this rsuant 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 representatives of this county to enter upon the abov ntioned property for inspection
rposes.
,_-� ignature (Applicant or Agent): r , V&,01
Page of
DAVE STEAVENS
Inspection Services
PROJECT Cts F1 I,ALr,;7.- L;zee-ar, PROJECT 44 - I
ADDRESS5(.I,AHq �Aj e-.L.rr &I :)e) 3
A Ott ,j-rA
BLDG. PERMIT #
ENGINEER SAJ,,11 tom :17f. JC—
INSPECTION TYPE
CLIENT
DATE )o
ARCHITECT
CONTRACTOR r j)
INSPECTION REPORT
i7 .A int I P J7 iJf3l c Ir.
1-4
AL,1„-
Itz— t-
1zq .3tL
id.
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
the locations of the work inspect6d only and does not constitute engineering opinion or project control.
CERT NO
6 Ik 41, INSPECTOR NAME
(P' t - Clearly)
DATE Cl`INSPECTOR SIGNATURE� �-,, Z