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04-4191 (RER)BUILDING & SAFETY DEPARTMENT P.O.. Box 1504 (760).777-70.12 78-495 CALLE TAMPICO r FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760),777-7153 BUILDING PERMIT Application Number . . . . . 1�104=0000419-1� Date 5/13/04 Property Address . . 55141 TA4GEEWOOD APN: 775-152-074- - - Application description . . REMODEL - RESIDENTIAL Property Zoning . . . . . LOW DENSITY RESIDE Application valuation 1500 Owner ContractorF ���Y 19 2004 ------------------------ PGA WEST A OWNER CITY OF LiiUiNTA 5 4 3 2 0 SOUTHERN HILLS FINANCE DEPT. LA QUINTA CA 92253 -------------------------- Structure 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 15.00 10.00 2.0000 HND BLDG 501-2,00.0 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 .001 .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: L9 y — 4 14 I Date: IG Applicant: mil ect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: A/ -F- Lo 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 Me applicant to a civil penalty of not more than five hundred dollars ($500).): tl��j 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 Leat the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builde, 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 DECLARATION V 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 issued. My workers' compensation ' ce carrier and policy number are: mer �7` r F7gyp cl�,r i,1-0 Policy Number %� a--671 _ I 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. e i_ pplicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL S T AN EMPLOYER TO CRIMINAL ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N 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 Lendefs Address ENT IMPORTANT Application is hereby made to the Director of Buildingand Safety APPLICANT CKNOWLEDGEo the 1. Each person upon whose behalf this application is made, each person at whoseeIrequest and for whose benefit tions and work 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 1 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 represe ives of this county to nter on the above -non ' n property for inspection purposes. J Signature (Applicant or Agent): Le �. . rye w�^:,�.».•t'44.'ro"ei��it�"' Fk#oS'•''3"h.:�."`..:rY+"•`'?' T. "°'' ;• •.+s.i:i++ 3h'S�YP4ah'? �•; iX�?'9i1'� t.relir AP 44 DAVE STEAVE,NS Inspection Services. PROJECT _PGA uJesr= ADDRESS 55-Iy BLDG. PERMIT # D (4 - 4.1 ENGINEER S A J D, E _._r_).4L. INSPECTION TYPE Page of 1 PROJECT #- CLIENT .�(, A l,c) tiS T N 0 A. . DATE ARCHITECT GO LB aA. A L t4. CONTRACTOR (7�}� t: t c .3c J)S INSPECTION REPORT _ALA&-r-ASa.A,ev\ iJ 4a.DWAP-6_:r-Q5,At-aT,uG;. oma.., rte.. 'Ze?r la AQR� ,S - 5t-jEA 1131�rnC��-� 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: © q 3' S�l� INSPECTOR NAME y A J rinbc early) DATE C� 3 .��C ci. UO y INSPECTOR SIGNATu