04-4294 (RER)F Oz
U �
B BUILDING'& SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
C�pF9`� 78-495 CALLS TAMPICO FAX (760) 777-7011
LA„QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 7.77-7153
BUILDING PERMIT
Application Number . . `04'000.04294- ;Y Date 5/17/04
Property Address,..,. . . . . . 54259'SOUTHERN HILLS
APN: 775-101-048- -
Application description— REMODEL - RESIDENTIAL
Property Zoning . . . . LOW DENSITY RESIDENTIAL
,.Application valuation.. 8000 �
Owner. Contractor
------------------------ ---------- p --- ----
PGA WEST RESIDENTIAL ASSN. INC OWNER
5432.0 SOUTHERN HILLS
LA QUINTA CA 92253 JUN 042004
- Structure Information ----eh-VOF-------=---
Construction Type . . . . TYPE V - NON RATED_ FINgIyCEpErA
Occupancy Type . . . ... . DWELLG/LODGING/CONE <=10
Flood Zone NON -AO FLOOD'ZONE
Other•struct info CODE, EDITION 2001 CBC
'Permit .. . . . BUILDING PERMIT
Additional desc
Permit Fee 99.00 Plan Check Fee....: .00
Issue Date Valuation 8000
Qty Unit Charge Per. Ex -tension
BASE FEE 45.00
6.00 9..0000- THOU` !�BLDG'2, 001-25, 000 , 54.00
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Special Notes and Comments
VOLUNTARY SEISMIC STRUCTURAL.RE'PAIRS
- - - - - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 7 - - - - - - - - -
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.. 99.80
W,
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: Q `/ Date: (D • 4/- v
Applicant: ---Architect or Engineer: //�� -�
Applicant's Mailing Address: Architect or En jneer's Address:
et (.Q
CA eloo
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.
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 provisiois 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).):
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 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 reason„
ateQ wner_
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following ceclarations:
I have and will maintain a certificaie 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.
!X 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. M�workers' compensation mance carrier and golicy nu bei are:
er GJ i 1� r i •J /Policy Nufter !!56 =,4P — 7rV'N
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.
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
Lender's Address
IMPORTANT Application is hereby made to the Director of Biildin and Safety ACKNOWLEDGEMENT
Ato the
1.. Each person upon whose behalf this application i s made, each person at whose ls questa d forohose benefit work isperformedunder or pus set forth on this rsuant 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 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 a e to comply with all city and county ordinances and state laws relating to building
construction, and hereby authori�ignature
e representatives of this county to enter upon the abov ntioned property for inspection purposes.
e (Applicant or Agent):
Page of 1 '
DAVE STEAVENS
=Inspection Services
PROJECT t�G t,J S� , C�Au-zR) 5 PROJECT # ..: ,I
. ADDRESS SSI -� ��' Som f ►riA►J !i [.S CLIENT .PGA W.e r + . N D 1P''
DATE -L`4:
BLDG. PERMIT# 04 4 a. q Li ARCHITECT OL B A A R Cwt
ENGINEER T�uvjJ Sfl s 016 =y L. CONTRACTOR Ptkc i.i= L
INSPECTION TYPE
INSPECTION REPORT
FOLLOWING LOCATIONS EPDXY, SMSON ETF.. EXP. (-0 S HOLES DEPTH CHECKED,
BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 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
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DATE .� �� . 01-(%(� j INSPECTOR SIGNATILIR ` a—,