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04-4172 (RER)BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7 )12 78-495 CALLE TAMPICO FAX (760)77.7-7)11 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).7'77-7153 BUILDING PERMIT Application Number . . . . . X04-000041772---� Date 5/13,'04 Property Address . . . . . . 54985 TANGLEWOOD APN: '775-152-056- - - Application.description Property Zoning . . . REMODEL - RESIDENTI- LOW DENSITY'RESIDEN11 . . . L Application valuation .1500 M,Ay 19 X 0 0 4 ,. Owner Contractor ---------------------- PGA. WEST�A OWNER iNT Cirl OF LES( U6A FIKIANCE DEPT. 54320 SOUTHERN HILLS LA QUINTA CA 92253 -------------------- - ----- S,,tructure 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 desc Permit Fee 35.00. Plan Check Fee .00• Issue Date . . . . Valuation . . . -1500 Qty Unit Charge Per Extension BASE FEE 1-C.00 10.00 2.0000 HND BLDG.501-2,000 2C.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 t r P.O. Box 15044.44" VOICE (760) 777-7012 713-495 CALLt TAM FAX (760) 777-701 1 LA QUINTA, CALIFORNIAI 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: 6 -Archltect or Engineer: C l� Architect or Engineer's Address: &C -;Ip 11T 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 � 1 applicant to a civil penalty of not more than rive hundred dollars ($500).): 1, 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. , B.8 P.C. for this reason n _ /Date ( I 6 4 -, Owner i WORKERS' COMPENSATION DECtARATION 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 flie�issueed. M workers' c_om�pQensation ins carrier and olicy u er a r �i.t 11 3 icy Number _ /yD _ Gl - Ll-; — 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. _ n A „ , uv 1w vinic nurvuKtu i NUUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES S N PROVIDED FOR IES AND SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 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.). Lenders Name Lenders Address ENT IMPORTANT Application is hereby made to the Director of Buildingand Safety APPLICANT aCKNOWLEDGEo the 1. Each Y permit subject to the conditions and restrictions set forth on this application. 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 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 represen lives of this county to enter upon the bov oned prope r inspection purpose ate V S' ature (Applicant or Agent): - `� •'�r+n-`..+.�'4''(� 01cyWT•"Y" 'u+.... .F r,+... ...w- ... _ _.. v,�:. 1 a jI Page of DAVE STEAVENS Inspection Services PROJECT �GA W c ',T - C-1 �Z 4 r; 0 S PROJECT # 0'4 - 1 to ADDRESS 544 9V, 9' ` r* -w LC 'Q 4*1 CLIENT 6, A t,..+J G. S � __ t�-1 p N LA ;��i ��t'i t�,,l1_:: DATE BLDG. PERMIT # (94 ARCHITECT r --,OL. j.� A AiZ CH ENGINEER bttjo J� le, Olt- CONTRACTOR V N C t F-1 C. INSPECTION TYPE INSPECTIONREPORT FOLLOWING LOCATIONS EPDXY SIMPSON ETF. EXP. HOLES DEPTH CHECKED, BRUSHED'AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945 LA* r L,l V. 1 Z'rr ,l _C 6f • t' }z #.ilztJW tAY �' f -�,r2. 1.1C �`1^LL`e :'�L':'W' f•� 4 c,.; i+tii + i1+t1 ' :'�" +'� 4a�..i+1 `4" 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 coves the locations of the work inspected only and does not constitute engineering opinion or project control. CERT. NO. 0859348-50 IVSPECTORNAME DAVE STEAVENS (Print -Clearly)-_ DATE C�' : t C✓ ,,'2t�F.i 1'4SPECTOR SIGNATURE � .•• *'+.• . �+�e—c .� .� i''A. � W L �- t � �3t��,tiE �ua a,r,• 11 A t.— tZ F!e l .,l, �.' . +`. i 1" x+r. i'L. f'+. • r i _ , r. 4...) . \ ... s.. pro.. •1. �, . :. i. ei r ... r $ 4 `-re.-sti t . l l.^ c R- r �-\ tv. L.. [ G. W ' s... �Y" ; ! -�'.. +. f� \ <v,. "° l • s.� t ._ t l�. 1. _ s S. , '�.�...: t,. : f.:.... i i.:,.. �' *w .. �`v. 1<;,,,, i 5 r'�l 1 . ` }\-• '. 1 '.. ' ', t4 L.., �� - •) r1 r 1:.. ! ...} r_� ' + ' i " lr,. � PPPe-� r~4' w"•. )L'; � � � ,k.:1C' 1 :.._-lw: '�".:� #�l i �.... i i ' l.. • � .++�.,�p 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 coves the locations of the work inspected only and does not constitute engineering opinion or project control. CERT. NO. 0859348-50 IVSPECTORNAME DAVE STEAVENS (Print -Clearly)-_ DATE C�' : t C✓ ,,'2t�F.i 1'4SPECTOR SIGNATURE � .•• *'+.• . �+�e—c .� .�