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04-4282 (RER)P.O. Box 1504 78-495 .CALLE TAMPICO I,A�QUINTA,, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT .(760) .777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number 047,0,Ob04282Date Property -Address;.. ,.54039 SOUTHERN HILLS . APN: 775 -101 -035 - Application description REMODEL -*RESIDENTIAL Property Zoning . . LOW DENSITY RESIDENTIAL Application valuation 8000 Owner Contracto --------------------------------- PGA WEST RESIDENTIAL ASSN. INC OWNER 54320 SOUTHERN HILLS. LA QUINTA CA,92253, Structure Information 5/17/04 JUNG 4 2004 CITY OF LA GUINTA . FINANCE DEPT. 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 91.0000 THOU BLDG. 2,00'1;-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 99.0.0 Plan Check Total .00 .00 .00 .00 Other Fee Total .80 .00 .00' .80 Grand Total 99.80 .00 .•00 99.80 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: Date: 60 — 0 Y Applicant: ----Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Addres : LR2% ic. No.: CRT ----A U BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 i . 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 Ihp applicant to a civil penalty of not more than five hundred dollars ($500).): PN I, as owner of the property, or my employees with wages as their sdle 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. , 13A P.C. for this reason Date Owner. WORKERS' COMPENSATION DECLARATION I 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 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 issued. My orkers' compensationj�ance carrier and policy num�err ar : ,Gamer —7T "7� rU dYC o�P licy Number _ / �/1 QS�I - zo - _ 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 paw forthwith comply with those provisions. -"' • - ZA. A 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). 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.). Lenders Name Lenders Address 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 Ouinta, 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 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 abov n ' ned property for inspection purposes. ' ature (Applicant or Agent): Page, i of DAVE STEAVENS ;Inspection: Services PROJEC ,Zt . � l � S (S PL .. t ►2 «5 . PROJ`EiCT # Da 5 - 1'? ADDRESS.54-63`� Soa -ICA a N,S C:LIENT W E74 ut►.� -a p... DATE : aD h-►R`f `4oD5" BLDG. PERMIT # a ,. 4 2A Z. ARCHITECT 60(_Zh A 2 c. iA ENGINEEWhAay SA606:!, 7tjL CONTRACTOR�LkF(L Lb INSPECTION TYPE INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SDvVSON ETF. EXP. l l - U S HOLES DEPTH CHECKED, . BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945. .. r fsr1-lAll=- a Lo �oUc5 - I bc?TV-1 L>,Tr-1.. fix-• - ' 2-iyi T�3orZL. d�5: L& 6-, ` �J0 Sr» its J � zw i S &L ,20hF1 Cl-fk k%_S �iLAvv` t �J (Q K fyz-z st.. �` o� S w -w -t -k7 D OF rL 1.1*(L_z'TL= P-� M? A M ( Q Cc, Ai2 a 7:. �� - LRT - Corr. jZ�t,lffT� x p fL : UJ R k.S _ \ l 2�l lam.) -A t_L A L i vJ 6 co 1% CERTIFICATION OF COMPLIANCE: To the best of our'knowledge, all of the reported work, unless otherwisenoted, substantially complies with approved plans, specifications and applicable sections of the building code's. This. repo rt covers the locations of the work inspected only, and does riot constitute engineering opinion or project contro` CERT.NO. '0859348-50,CE3 INSPECTOR NAME DAVE STEAVENS (P)rnt Clearly) DATE 30 CC, 1 2-0 0 INSPECTOR SIGNATUPFC � 0_ -- ,�