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04-4196 (RER)`.w P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application. Number . . . . Property Address . . . . APN: Application description Property Zoning . . . Application valuation . . Owner ------------------------ PGA WEST NOA 54320 SOUTHERN:HILLS LA QUINTA CA 92253 BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 (04-00004196 Date 5/13/04 5-5-1-71 TANGLEWOOD 775-152-079- REMODEL 75-152-079 REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 1500• � 1 Contractor ---------- ----------. OWNER MAY 19 2004 J CITY OF LA Q?sUjN7**A FINANrF nr-n4 Structure Information Construction Type . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . NON -AO FLOOD ZONE Other struck info . CODE EDITION 2001 CBC ----------------7----------------------------------------------------------- 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 Permit Fee Total 35.00 .00 Plan Check Total .00 .00 Other Fee Total .50 :00 Grand Total 35.50 .00 Credited .00 .00 .00 .00 Due 35.00 .00 .50 35.50 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: itect or Engin 6 L66eer: f �12P�'"1 . i� Architect or Engineer's Addres ,f -tic. No. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 b applicant for a applicant to a civil penalty of not more than five hundred dollars ($500).): y any PP Permit subjects 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. or thiis%easo ,s e �' I°I Jr, M. n �A ti . �► WORKERS' COMPENSATION DECLARATION - 1 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 vers' compensation inns u a carrier an policy nu �@r re: artier rA i� l t/ J� -olicy Number ) 46 �4 / �--- D 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, I shall forthwith comply with those provisions. ate scant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALLSU4 T 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 Buildingand3ty a Safety aACKNOWLEDGEMENT the set forth on this 1. Each person upon whose behalf this application is made, each person at permit eihose requ st and for whose benefit work sndifions andnperformed under or pulrsuant 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 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 ply with all construction, and hereby authorize representatives of this county to a er u n the abov nti property for ins and county ordinances and state laws relating to building P PertY pectin purposes. Date ignature (Applicant or Agent): -..... _.. __ - - -•r .•. -. j .. 7..r! .:. n r.w �n..�..r..• �»v...r : K � 4.. -L . -r..rr+- _ f w' a.a. •,- _ r r. M LP Page of 1 •�' DAVE STEAVENS Inspection Services PROJECT 06 1� W -E5 l - 6a e6�,eO S ! PROJECT # a o v y ADDRESSA5'S-11 k -T"•r V. et,.Cwoo� CLIENT Ix (v A t -j G $ -r W o A • l..A Q � . DATE' w L4 S z -p- ' -4 D `� BLDG. PERMIT # ARCHITECT GOL 8 A A 2 GW ENGINEERI ky O SA J a tt:—. Z �1L . CONTRACTOR PA C r r i C BLD S INSPECTION TYPE I INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SIMPSON ETF. EXP. J - y 5- HOLES DEPTH CHECKED, BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945. 0 Z)LC 5 -- D �r �x iE�Jr'i1y-,1 +,o�S- �oc.�5�1�.`��?TW �"1)iA• 12o�s• 17��1,.�A,�L7h� �� lA. ALL 1ZCPA#fL A4CA'5- F2ar,t.K)& (4A(z1�t,JA1Lt, i'#J6ceL4-re0rJ 0MlJ2ir�. r A (-L A Nt AS • S t4 e AfL tJ X I t.. t#JG- C M- 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. 0859348-50 DATE INSPECTOR NAME DAVE STEAVENS _ Print Clearly) INSPECTOR SIGNATURE \ �