04-4188 (RER)' � �IGGl�iiV
4
BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 , (760).777-7012
78-4.95 CALLS TAMPICO FAX (760)"777-7011
LA QUINTA, CALIFORNIA 92253. INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number .
Property Address
APN:
Application description . . .
Property Zoning
Application valuation..
0.0-0-0418-8
55027 TANGLEWOOD
775 -152 -060 -
REMODEL - RESIDENTIAL
LOW DENSITY RESIDENT
.1500
Owner Contractor
------------------------ -------------
PGA WEST OWNER
54320 SOUTHERN HILLS_
LA QUINTA CA 92253
Structure Information
Date 5/13/04
a 0 1
( 19 2004
CITY OF LA QUiNT6A
FINANCE DEBT
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
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
.00 .00
.00
.00
Other Fee Total
.50 .00
.00
.50
Grand Total
35.50 .00
.00
35.50
P.O. BOX 1504 • ,
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date: 51tC1164—
Applicant: Architect or Engineer:
AeczApplicant's Mailing Address: Architect or Engineer's I
c�s� ► AyE .
10
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.
-L nse 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 b applicant for a
tha applicant to a civil penalty of not more than five hundred dollars ($500).): y any pp Permit subjects
Jm(�1 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.& P.C. for this reason
tzate G `:� Owner
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
of the work for which this permit is issued.
I have and will maintain workers' compensatio 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 in nce carrier and policy number a
'amer- S' T } 7 -F- 7=�w y 0-;0olicv Number __J S (' GTS"- re: /)
_ 1 certity 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.
�afe QApplicant1A �'L'?
WARNING: FAILURE TO SECURE WORK RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHA! SUBJECT AN EMPLOYER T
CRIMINAL
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES SPROVIDED FOR IN AND
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
Lenders Address tj 1A
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 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 up n the above ntio rope for inspection urposeS.
ate -5 Q� gnature (Applicant or Agent):
G Page j of x
DAVE •STEAVENS
Inspection Services
rt
PROJECT�[�A PROJECT # a O U y-
ADDRESS'S- S-oall �"Aay.,t�L,,c7c,Z_ CLIENT ?G A
LP, DATE 30 Su c_`f
BLDG. PERMIT # 0 4. - Ikk 9 ARCHITECT Go LP. P fl R -r- W
ENGINEER -u oy) Sk6p i E .TrJc. CONTRACTORPctrc-
INSPECTION TYPE
INSPECTION REPORT
FOLLOWING LOCATIONS EPDXY SMIPSON ETF. EXP. - D 5 HOLES DEPTH'CHECKED,
BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBG 4945
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CERTIFICATION OF COMPLIANCE: To the.best of our knowledge, all of the reported work, unless. otherwise noted,. , t
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. r
p
CERT. NO. 0859348-50
DATE
INSPECTOR NAME DAVE STEAVENS
rini Clearly)
INSPECTOR SIGNATU