04-4168 (RER)BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7C 12
78-495 CALLS TAMPICO FAX (760) 777-7C 11
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7 15 3
BUILDING PERMIT
Application Number .. . . . .
Property Address . . . .
APN:
Application description
Property Zoning . . .
Application valuation . . . .
Owner
------------------------
PGA WEST 1-404
54320 SOUTHERN HILLS
LA QUINTA CA 92253
04;0-00=0416=8� Date .5/13-'04
54961 TANGLEWOOD
775-152-052- - -
REMODEL - RESIDENTIAL
LOW DENSITY RESID
1500
Contractor
OWNER
Structure Information
IAL A I�
----- -- 19 2-04
CITY OF LA QW47A
aA
FINANCE DEPT.
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 desc
Permit Fee
35.00 Plan Check
Fee
.00
Issue Date . . .
. Valuation
. . .
. 7500
Qty. Unit Charge Per
Extension
BASE FEE
1E.00
10.00 2.0000 HND BLDG 501-2,000
2C.00
Special Notes and
Comments
VOLUNTARY SEISMIC
• U
-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
.0.0 .00
.00
.00
Other Fee Total
.50 .00
.00•
.50
Grand Total
35.50 .00
.00
35.50
ti
P.O. Box 1504 • �� VOICE (760) 777-7012
78-495 CALLE O FAX (760) 777-7011
LA QUINTA, CALLIFORIFOR NIA 9225344 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date: J (�
Applicant: hitect or Engineer:
Applicant's Mailing Address: Architect or Engineer's •Adddre§s:
DIAEzo
o. G1�I D 1
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
thQ 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. for this reaso
/date ner
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
-)6of thework for which this permit is issued.
1 have and will maintain workers' compensation " rance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I issued. M o;rkers' mpensation i nce carrier and 1* number a e:
mer — �i/1N�f15� olicy Number _ l S O �1 �� —�
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' corn nsation provisions of Section 3700 of the Labor Code, 1 shall
D�forthwith comply with those provisions.
ate 1 plicant
WARNIN : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND HALL 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
IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT and Safety for ACKNOWLEDGEMENT
to the condifions and
s set forth on this application.
1. Each person upon whose behalf this application is made, each person at permit
request and for whose benefit work isnperformed 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 representatives of this county to enterupon the ab a en .oned property for ins 'on purposes.
�ignatur.licant or Agent): W_7 Q
ow— 0 ---to
t!�'� � ► I
• DAVE STEAVENS Page of
Inspection Services
PROJECT A LJe-S 'Z- - Ca tc r- C A) K PROJECT # o v L4 ~ � Co
ADDRESS.T44 -941 "Trt1MGLC t.t ?yra t) CLIENT PGA W t- Si" N v ii
. A C7u i �J"r A*, CA , DATE (q
BLDG. PERMIT # C ^ L) 1 ARCHITECT 60, L,.?, A A Iz L- 'A
11
ENGINEER ju.iis SAOvIc CONTRACTOR 4'Aci )-+ c Z L J `:�
INSPECTION TYPE
INSPECTION REPORT
FOLLOWING LOCATIONS EPDXY SMIPSON ETF. EXP. �Q, - c: — HOLES DEPTH CHECKED,
BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945
4
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
(9substantially complies with approved plans, specifications and applicable sections of the building codes. This report coves
1 the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 0859348-50
DATE -23 J�e e Z dd 4
INSPECTOR NAME DAVE STEAVENS
"^(Print Clearly)
INSPECTOR SIGNATURE