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04-4295 (RER)P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number Property Address . . . . . . APN: Application description . . . Property Zoning . . . . . . . Application valuation . . . . BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 04-00004295 Date 54287 SOUTHERN HILLS 775-101-049- - - 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 or�j6UN 200401 CIY'Y OF LA QUINTA FINANCE DEPT. Construction Type . . . . . TYPE V - NON RATED 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 Extension BASE FEE 45.00 6.00 9.0000 THOU BLDG•2,001-25,000 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 -7 .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 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: 0 1q - y -1_q Date: - <% -0 y Applicant: Architect or Engineer: Applicant's Mailing Address:Architect or Engineer's Address: rt,c:,- C.0 C(M >�c ic. No.: 0I(c'-4 2Q C3UILUINU F'tKMIT 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. 1� t f r `1.•. r,... Date r i �l Contractors I# �t 4'., tt k F;t t<i VIIZ I.1 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 br.'she is'licehsed'p'ursuant to the provisions of the Contractors' State License Law (Chapter 9, (commencing with Section 7000) of Division 3 of the Business and Professions Codej' o,tliat`tie or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 b applicant for a the applicant to a civil penalty of not more thain five hundred dollars ($500).): Y any PP Permit subjects ( 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 .l am exempt under Sec. , BA PIC. for this reason Date_ 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. ._Xof 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 workers' compensation ance carrier and policy number are: r �';!.z Policy Number _ ISp�G�GI4-' a� _ 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 come subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ate Applicant 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.). Lendefs Name Lender's Andress APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand a s set forth on this 1. Each person upon whose behalf this application is made, each person at whosee Irequest and for whosecondifions and ose benefit s work performed under or pulrsuant 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 comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ent r upon the above boned property for inspection purposes. ate igS' ure (Applicant or Agent):