0206-072 (BLDG)! ,f hereby affirm under penalty of perjurythat,I am licensed under provisions of
r -Chapter 9 (commencing.wlth Section 7000) of Division 3 of the Business and
�N.W -Professionals Code, and my lice se Is in:full force and effect.- �,.,
,� %1
��.1,3•� +ucenseJ�# l t�pe�I ,� h, LIC: Clacc Date
4 � • ,
�- W
t Zate 4= Signatureof'Contractor'`"-!
0.�OWNER BUILDER 4ECLARATION x' �=
W t` I. hereby affirm ugderpenalty of pegyry that I am exempt fromAhe Contractor's
License Law forthe following reason .
Z I, as owner offhe property,• or my•employees with'wages'as their sole
1 ; ! ;. ;Cbiripensation, will do the work, and the structure is not intended or offered for
sale (Sec 7044; Business& PFofesslonals Code);
:I; `as owner gt the properly, am exclusively. contracting with ,licensed
_ contractors to construct_ the' project (Sec: 7044, Business & Professionals
�, .� ( ) I am exempt' Under,Section F . - ` , B&PC Iior this reason
0� ':Dat" ' r,r `'' # SignaUWof,&•C i r- # /' s r~ V
. d Z r by ' $ WORKER'S COMPENSATION DECLARATION
I hereby affirm under penal y of-pedury•one-of the following declarations:
r, _T( ); I have and maintain a certificate of consent to self -insure for workers'
X ,LL ,�co(mpensationiasr1.provided*for 6y Section;$700 of. the Labor Code, for the
0, performance of the work for which this,permit Is Issued.. ;
t �s . •� :- ,,,,
Q;(� I I have and'will maintain workers' compensation insurance; as required by
O,�ea : Ii�T n 3700 of the LaborICode fog the performance'of the work for which this
v� 'permit is Issued.' My workere, compensation Insurance carrier &, policy no. are:
`r Cartier ,.I. C}i0j41"1E1. CO ` ' � Policy No.,.ArC31�82SS
�.cr� .,'dry" ik. r r �; v3•. ,, ; •� r
t(Thie`sectIon need not ;I fl: if the peimft Valuation Is'for $100.00 or less).
` I certify that in the pertorman`'ce'of the work.for,which this permit is issued,
.1 shall not employ any person in any manner so as to become subject to the
", r` _ `,workers' compensation laws of Califomia; and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I a aal f rthwith comply with thosl�
'Applicant.
'
4 Warning: Failure to secure Workers' Compensation coverage is unlawful and
Shall subject an employer to criminal penalties and civil fines up to $100,000, in
iaddition to the cost of compensation, damages'as provided for in Section 3706
of the Labor Code, Interest and attorney's fees
Z-11
IMPORTANT. Application is heretiq made to the Director of Building and Safety
rfor -a, permit aupject to the condition's and restrictions set forth on his
applicatlon + r •;•
r1 Each person upon whose belialflhls application is made &each person'at
whose request and-f&,whose benefit work is performed under or pursuant to
t any permit Issued as a result`ofthis appliceton agrees to, &shall,, Indemnify
& Mold harmless the �Ciryof La Qulnta, its officers; agents end employees.
2 Any: permit issued as a result'ofahis application becomes,null and void if
_ . Work, a -not commenced within.180`days fromdate ofiissuance of"such
,r permit, or: cessation of,work for:.180 days will subject permit to'canc`eiiation.
a=f certlVttiatI have read this application and State that the. above information is r
• r '•,c16 r 't..l.agree,to comply: with. all City,•and'State laws relating to the building
I construction, and hereby authorize.representatives of this Cl; to enter upon
£: the above ,mentioned'property foraanspection purposes,
r Ignatyre (Owner%Agent)' •• Dater Vie"
•--�r '=� r rfl ` kn• ' �— 6a—rte--- —
' � w • ��,tsUIL:UIIV�irF!t1iIVi1.1 � "y�, r �'' ."�`�' '`, _ ���;�'
,:ox�m�
DATE' + yi VALUATION h .LOT p- TRACTS er rt
iii +:1 -- !'v �:�5=tt
y' •r t:Ar' 1 ' 1a•� - ,1.
r
JOB SITE'
ADDRESS' SLW. 3
APN ..
OWNER r i •,
CONTRACTOR / DESIGNER/ ENGINEER,
'• P(iA W�'T` M%.flQDEN�AL i3QMt'�UWNBft�3
y
� V17�,�12,8 I�tJxiY�AM�f� �
FtO, Box 1060
,::
5080 9lIiQRJE3AlSut FhAlC'B �1lJ� . "` ;
LA QUINTA CA 92253
SM AtRtio 122
J ; _.
(1338)535.1475 5023
K
a
-
USE OFy PPE�EyRMMI�ITpp
�Jli�iL[V'1l.r BEd'.f{a0./JSV�.T
_ i -
SEISMIC PY.TRO•lriT; OLDO. 3: 94.383, 94. 80, 94.993,
f34.681� 34-tS97, �9.6l3„ 9!1-614, x'4.623 -
V,ALU.A►T)ON fis 000.00 LAI
` EMMAi11<D COST Or CONMTl'MON
Pte.FM NUUMARY
CoNsTRt1CTION nE 101.0010.4.18.000 i9S9.9A
STRONG MOTION IU . RM11) 101-000•241-000 $6.00
xy
tN�
` t
i
Mys:wTAt +CO' NUMU `1xON•AND PLM L 12p/� IC
. a•.. •. tra.. --,r. ..,.a.. .. IMFlIJ . PRE -PAID .gpp
/ Fdi,G
f.'jr $0..00,
t. TAL PX118W, 1Z DUE NOW •
AUr .2-'i 2002
FINANCE DEPT.
:RECEIPT
DA E ::
$c�
$Y 1
DA NA D
INPPECTA
J
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Badu
untiffgmurw Duds
Fo=&-Foo&W
Ducts
Slab Grade
Return Air
Steel
Combustion At
Roof Deck
Exhaust Fans
ox to wrap
FA.U.
Framing
Insphow
Vents
FirelAce P.C.
Grills
Fireplooe T.O.
Fans & ConVols
Party Wap kwation
Condensate Lines
Party Wad Firewall
Exterior Lath 0
D - int. Lath
14
Final
Final114 -POOLS-SPAS
BLOCKWALL APPROVALS
Steil
Set Backs
Elec:tria Bond
Footings
Main Drain
Bond Beare
Approval to Cover
Equipment Location
Underground Electric
Undergmund PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste tinea
Heater Final
Water P4* g
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower P=
O.K. for Finish Plaster
Sewer Lateral
Pod Cover
Sewer Connection
Encapsulation
Gas Pi 'ng
Gas Tesi
Applianm
Final
Final
Utility Nofte (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Widnq/
Low Voltage Wiring
Fbdures
Main Serums
Sub Panels
E)derlor ReceptaclesG.bf/
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
/wx, L�
9��`d ?� ,�iw �oZ-Voz-.
/
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XAJ
r� �,,//,�,�
�/t//1/ �9�(�/9 '$;A�- S55hoo 66;61Z
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04
W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
W .733553� B MC 3/31/01
Z Date d Signature of Contractor
O �
J V OWNER -BUILDER DECLARATION "
W W i hereby affirm under penalty df perjury that.l am exempt from the Contractor's
~ License Law for the following reason:
Z ( ) 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.
safe (Sec. 7044, Business & Professionals Code).
( , ) , I, as owner of the property, am exclusively contracting with licensed
contractors to construct the .project (Sec. 7044, Business & Professionals
Code).
c () I am exempt.under Section B&P.C. for this reason
NDate. Signature of Owner
pN . . _. --- -_. •... _.. ..... _
0>
a Q WORKER'S COMPENSATION DECLARATION
o Q 1 hereby affirm under penalty of perjury one of the following declarations:
In P p () 1 have and will maintain a certificate of consent to self -insure for workers'
X. W !L compensation, as provided for by Section 3700 of the Labor Code, for the
O-1 Q performance of the work for which this permit is issued.
m Q U (;) 1 have and will maintain workers' compensation insurance, -as required by"i'
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
a: � Z permit is issued. My workers' compensation insurance carver & policy no. are:
Caner LEGION INS. CO. 'Policy No. 9VG31T08185 .
p
n
g (This section need not be completed if the permit valuation is for $100.00 or less).
( )_ 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 1 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
3 • Code, I shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil firies up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Ouinta, its officers, agents and employees.
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 cessatl V titwork 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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for Inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#---^-'-- —"'---
72
DATE VALUATION LOT TRACT
$6oA00.00JOB
SITE
ADDRESS, BLDG. 3 TANt3•LEWOOD
APN
OWNER
CONTRACTOR/DESIGNER/.EN INFER
PGA WEST RESMDMAL HOMEOWNERS
S WERMERS MULTI -FAMILY CORP
P.O. BOX 1060
5080 SHORHAM PLACE #105
LA QUINTA CA 92253
SAN DIEGO CA 92122
(858)535-1475 CBL# 5023
USE OF PERMIT
GRATER AT _ BU11 DING
SEISMIC RETROFIT; BLDG. 3: 54-593,34-599,54-595,
54-60i, 54-B07, 54-613, 54-619, 54-6Z5
VALUATION 60,000.OD L3
'ES'TlMATED COST OF CONSTRUCTION
60,000.00
PERNIIT FEE SUMMARY -
CONSTRUCTION FEE 101-000-418-000 $459.50
STRONG MOTION FEE . RESID 101-000-241-000. $6.00
SUB TOTAL CONSTRUCTION AND PLAN CHECK
$465.50.
LESS PRE -PAID FEES
$0.00
TOTAL PERMT FEES DUE NOW
$465.50
r `
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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