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04-4305 (RER)a, ° BUILDING.& SAFETY DEPARTMENT w4 P.O. Box 1504 (760).777-7012 OF.9w`' 78-495 CALLE TAMPICO �. FAX (760) .777.-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153 BUILDI,NG'PERMIT . Application Number . . . . X014=0:0-0:04:3=0_'5-7 Date 5/17/04 Property. Address'". 54555 -"SOUTHERN HILLS APN: 775-101'-059- - Application description `REMODEL.- RESIDENTIAL Property Zoning LOW DENSITY.RESIDENTIAL Application valuation 8000 Owner Contrac e PGA WEST'RESIDENTIAL ASSN -.-INC OWNER ` 54320 SOUTHERN HILLS ; JUN 04 2004 LA QUINTA. CA 92253' CITY OF. LA QUINTA FINANCE DEPT. ---------==------ - ---- --- Structure'Information---------------------,-;- `Construction Type TYPE V- NON RATED - Occupancy Type DWELLG/LODGING/CONG <=10 Flood. Zone . . NON -AO FLOOD ZONE Other 6truct info . ... . CODE EDITION. 2001 CBC Permit . . . . _ BUILDING PERMIT Additional desc ..Permit Fee-9.9.00Plan Check Fee .00 Issue Date . . . . Valuation 8000 Qty Unit Charge Per Extension BASE FEE 45.00 6.00 9.000.0 THOU, BLDG 12,001=25,000 54.00 Special Notes and 'Comments VOLUNTARY SEISMIC -STRUCTURAL REPAIRS 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 .00 .80 Grand Total 99.80 .00 .00 99.8.0 v P.O. Box 1504 /; , w 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: Applicant: Applicant's Mailing Address: W Date: �o - � -� c itect or Engineer: /'�� ,+ �l- Architect or Engineer's Ad ress: - Cps GQ No. 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. Data Contractor 11 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 time 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 s 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 riot 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.). (-„) 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 jeason WORKERS' COMPENSATION DECLARATION 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 k 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 ��issuedd �My worts' corn ensation insurance carrier and, licy nu bar arm JG Tier 4q Wr4� Number 1 D S y 4- - _ 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 sho brme 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 SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IWADDITION 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.). Lenders Name Lender's Address kac 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, indemnity 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 I have read this application and state that the above information is correct I agree to mply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above menti roparty for inspection purposes. /fiea (Applicant or Agent): ! T. 4 y ON Page:_ [ 'of f• DACE STEAVENS Lrispection- Services. '. PROACT3� 1� x)EIT - (O,Au:ARkG .. PROJECT.# .2. S- -t. CLIENT�l _u:ADDRESS5L1 LA Qui ►J<,P . C.4i• DATE ' .arl N? PZ kL. a bo BLDG. PERMIT # 6,q - 41a -g- ,- ARCHITECT, Ca OL iS P\ J4 ✓LC FA ENGINEERr, M.,)c i CONTRACTOR Pflct F INSPECTION TYPE .:INSPECTION REPORT FOLLOWING LOCATIONS EP.OXY' SUAPSON-ETF. EXP.- /I HOLES DEPTH CHECKED, BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945 t�nRS a�T1r1- �l,c�GS' i"\oucs • 101 �2C►� �A �01�5 - .I"1z' �F:J��1 '�' i w h--x�: w,�.s. "1��- a �u�So`�cs-- 1v �-.PTw �`.� ��; "RoDS.�.1��2t c�..tc�Ta 'fig ��-L.- �ODT ��TA1C.S'"• ZAu►�1aJC� N.AdLDUJPQ.�-. �SU�I.RTtyJ 2005=' b�TrR� �U6 Play IVRi�t\(� CDM.PLz_I- (=•7CT. Au'S'- T: At .i (_ . ei�(Li��.��,R� .�JSt�� c) �. S�iCti i(L RU ty 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. 0859348750' INSPECTOR NAME DAVE STEAVENS . �/ DATE ' T S (�P_ T INSPECTOR SIGNATUP,E.. aL 4,