05-1113 (RER)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 _ (760).777-7012
78-495 CALLE TAMPICO ' -� .. FAX (760) 777-7011
LA QUINTA, -CALIFORNIA 92253 INSPECTION REQUESTS (760) 7,77-7153
BUILDING PERMIT
Application Number 105-00001113 Date 3/25/05
Property Address . . . 55213 TANGLEWOOD
APN: 775-152-001- -
Application description'. REMODEL - RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation . . . . . 1500
Owner- ------------- Contractor
-----------------------1�---8-
PGA West OWNER
54-320 Southern Hills APR 04 20.5
LA QUINTA, CA 92253 CITY OF LA QUINTA
-----=--------------------
Structure Information - -------------------------
Construction Type
. . TYPE V - NON RATED
Occupancy. Type
DWELLG/LODGING/CONG <=10
Other struct info
CODE EDITION
2001
-------------------------------=---------------------
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.d0 2.,.0000
HND BLDG 501-2,000.
20.00
Special Notes and
-----------------------------------------
Comments ,•
Seismic Retrofit
Phase 4 Greens units'
Voluntary construction
----------------------------------------------------------------------------
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
do,
.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: 06-1113 Date:
Applicant: I Architect or Engineer:.
Applicant's Mailing Address:
I hereby affirm under penalty of perjury that I am licensed
Code, and my License is in full force and effect.
License Class
Date . Contractor
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
License No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate 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 applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 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.).
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
ate G wner
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' 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 insurance carrier and policy number are:
Carrier Policy Number
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 co with those provisions.
ate v II V
Fant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL 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 /^
Lenders Address 4
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, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act o, 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
constructio an .hereby authorize representatives of this county to enter u on thq above-mentioned proparty for inspection purposes.
I Gvj/,/ -4
e ature (Applicant or Agent):
4I` 4
Page of
DAVE STEAVENN
Inspection Services
PROJECT (.P 5
ADDRE'SSS
BLDG. PERMIT ..# OS- l (t 3
ENGINEER ��,�, swool Z,ac. .
INSPECTION TYPE
0
PROJECT
CLIENT (a W S -C-. w o R
DATE. 20'!5'
ARCHITECT . r O L8 A N rt_L t_X . +'
CONTRACTOR?�.r Ar=tc_��5
INSPECTION REPORT
FOLLOWING LOCATIONS EPDXY SIN TSON ETF. EXP. (( -o 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,
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, INSPECTOR NAME DAVE STEAVENS
\ (Print Clearly)
DATE Z TA kJ LV d t!p INSPECTOR SIGNATUP,E . as