04-4285 (RER)P.O. Box 1504 '(760).777-7012
78-495 CALLS TAM.PICo FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153
BUILDING PERMIT
Application Number . . . .
Property Address,;
APN:
Application description .
Property Zoning . . . . . .
Application valuation
X04--000042"85 _� ..R --Date
54075 SOUTHERN HILLS
775-101-038-
REMODEL
75-101-038 REMODEL - RESIDENTIAL
LOW DENSITY RESIDENTIAL,
8000'
Owner Contract
---------------------
PGA WEST RESIDENTIAL ASSN. INC OWNER,
54320 SOUTHERN HILLS
LA QUINTA CA 92253
Structure Information
5/17./04
Construction Type..
: TYPE V -;NON RATED
Occupancy Type .
. . . . . DWELLG/LODGING/CONG <=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
Extension
BASE" FEE,
45.00
6.00 9. 0000
THOU '-`BLDG 2'-,-0'0'1'25,000 2
54.00
Special Notes and
Comments.
VOLUNTARY SEISMIC
STRUCTURAL,,: REPAIRS�,:
- -----------------------
---- ------x ---------- --------=--------
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
. 0..0 .00 00 .•. ,
.00
Other Fee-Total,
.80 00 Ob°I
80
Grand .Total
99.80. .00 .00
99.80
P.O. Box 1504 • VOICE (760) 777-7012
75-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date: q' oy
c itect or Engineer:
- Leo r 6i4 AwA.
Architect or Engineer's Address:
USU 10 Are-
IS
re .
5.-C). CA Ci2io
ic. No.: qlM
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 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).):
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 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 A _
Date -6-4- c) 4— Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
nl 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' compensarance carrier and policx n r re:
Carrier -7ti�?= h'Tw w3'i> Policy Number r Shy ' Z�ry
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
d forthwith comply with those provisions.
ate (V•T. d � nt
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 permlt is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address _ A
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 employeesfor 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 agreV9 comply 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 -m ' ned property m on purposes.
�te �D • 1 (�F' nature (Applicant or Agent):
44
3 Page l of
DACE STEAVENS
:.Inspection Services
alp=; 1 . >:
PROJECT PIv
&A i,.��ST -:GP-L _s(L�5 -PROJECT # a?0 5';� Ii: .
ADDRESS'Sq-0r7 SouTMGna pit��5 CLIENT .�Ca� VJ 5T H0 Pt':
LFN ("j��.PTP e:�a. DATE J(Q. Si.)-L
BLDG. PERMIT-# O `-i LA L6 S' ARCHITECT
ENGINEER��,,:►,� SA U u I �
CONTRACTOR G� � � c. T ►)
INSPECTION TYPE . r
INSPECTION REPORT.
FOLLOWING LOCATIONS EPDXY. SHVIPSON ETF. EXP. - U (fl HOLES DEPTH CHECKED,
BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS .PER ICBO 4945
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CERTIFICATIONDF C.OMPLIANCE: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 hot.coristitute engineering, opinion or project control..
CERT. NO. 0859348-501 C$ INSPECTOR. NAME DAVE STEAVENS
rint:Clearly) .
DAT E�� v S INSPECTOR SIGNA6PF 1 �s D
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TO: St1m lied, ReCOnSt ucgOn Manner Fnm, RNETT M. SAVOIE
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Fax •764-T7tt6 .
Pages: i ckK inmcow sheer
Phww: 7-771.1234 x 17
Dab: Tuesday, Au9usf02, 2OD5
Re: PGA West Reconsbuc1jj_ . CC:
wie-6ae .. .
!� dr�n� @!• "
nupwL
eek
riv
Is—
that
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t JJJ
impel the bm&Aaftn e<�rt� n®fitaa of- -
tim wed details:
1) ®ifting room shear wrap P2 (3M>Omit w cwk at vmn & detaita 1153 & 31SL"
2y
Plowso feel free to Act me if
You have any further questione. Th—p:rk_. Rhatt