04-4814 (RER)X
OF Tti
BUILDING, & SAFETY DEPARTMENT
P.O..BOX 1504760).777-7012
__a 495 CALLS TAMPICO FAX (760) 777-70I 1
A QUINTA, 'CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
�U� 15 204 BUILDING PERMIT
zitMAid��t�l�®�i er �04-0`000481:4 Date 6/07,/04
r-operty Address 5413-5 SOUTHERN HILLS
APN: 775-101-043- - -
Application description "., .REMODEL —RESIDENTIAL
Property Zoning LOW DENSITY RESIDENTIAL
Application valuation . . . . 8000
Owner Contractor
PGA WEST "RESIDENTIAL ASSN. INC OWNER
54320 ,SOUTHERN HILLS _
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
200.1 CBC'
---------------------------------------------- ---------------- -----------------
PermitBUILDING.:,PE, RMIT
4
Additional desc t °q
Permit Fee 99.00 Plan Check Fee
00
Issue Date Valuation
8000
Qty Unit•Charge Per
Extension
BASE FEE_
45.00..
6.00 9.0000THOU, . B•LDG 2,'001-25, 000 '
54.00
----------------------------------------------------------------------------
Special Notes and Comments ..
VOLUNTARY SEISMIC STRUCTURAL REPAIRS _
-------------------- ------------ - ----------------.------------
a
,-="---------
Other Fees STRONG MOTION (SMI) -RES
80
Fee: summary Charged Paid Credited
Due.
.Permit.Fee Total 99.00 00. .00
99.00
Plan Check Total .00 .00 00
.00
Other Fee Total .80 00 ;' :.Oro
8.0
Grand Total 99.80 .00 .00
99.80
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING g SAFETY DEPARTMENT
Application Number: 014, [-%y) 14
Applicant: I Architect or Engineer:
A%ppincant s mailing Address:
VOICE (760) 777-701:
FAX (760) 777.701;
INSPECTIONS (760) 777-7153
Date: -1
ff. 0 41
Arcniteci or tnglneer's Address:
Lic. No.:
t3UILDING PERMIT DECLARATIONS
I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION
perjury that 1 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 tull'force and effect.
License Class License No.
Date Contractor
I hereby affirm under penaltyof OWNER -BUILDER DECLARATION
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
the 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
applicant to a civil penalty of not more than five hundred dollars ($500).):
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.).
U 1, as owner of the property am exclusively contractieg 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.).
I hereby affirm under penaltyof MNUKKtK5' COMPENSATION DECLARATION
perjury one of the following declarations:
AI 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.
ll 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
Sisued. fly wo�rs' compensation in�stlm��e carrier and Eoli�y urypgi are:a�
Cartier N olidicyNumber _I.St,`9 `i SL
_ 1 certify that, in the performance of the work for which this permit is issued. I shall not employ an s to become subod to the _
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisionsyof so aection 3700 of the Labor Code. I shall
forthwith comply with those provisions.
Date / plicanl
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 (s100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury that there is a construction lending
CONSTRUCTION for tLENDING oAGENCY
oC he work for which this g permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
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.
I. 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 Write, 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 deyti from date of issuance of such permit, of
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this applicatiori and state that the above information is correct. I agree to comply with all city and county ordinances and state laws reletinp to building
construction, and hereby authorize representatives of this county to enter upon the a n
ed property for inspection purposes.
ate 41&_�_�n_atura (Applicant or Agent):
Page of
DAVE STEAVENS
Inspection: Services
PROJECT PROJECT # .a 00 5 -
ADDRESS CLIENT 7)&. R Wt
C.14 �uy i A� A DATE 1 O to
BLDG. PERMIT # O4 -.Lf g l 14 ARCHITECT (f,0Li36 l�1:2Ch1 "
ENGINEER
FJ SA�1o�.��L CONTRACTOR t�Rc F LADS
INSPECTION TYPE
INSPECTION REPORT '
FOLLOWING LOCATIONS.EPDXY SRAPSON ETF: EXP. 1 -OCo , Il -0S HOLES.DEPTQCHECKED,
BRUSHED- AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER'ICBO 4945-
C=x "t3�.a �- 1 �:c��S-'t"tULcs - 1 of � c►-� l A . 'ROtS t'1
C. . i� 52.E A ct.c , R u = FJ 5u AT ►� _' C a "" ;� l_�'.G""�
` E,L : 2 W A
�toOr- An1�s �ly tvP1�J(,�- •��r7L.c't�"'.
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. 0859348-50i.0 g INSPECTOR NAME DAVE STEAVENS
_ ,c- �. Pri Iflazf
DATE / ��r �UQ, INSPECTOR SIGNATUP,F,