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04-4287 (RER)BUILDING '& SAFETY DEPARTMENT P.O. Box 1504 (760)•777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LAtQUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . .. 04--0000428-7 - / / Date 5 17 04 Property Address 54099 SOUTHERN HILLS APN: 775-101-040- - - Application description REMODEL - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation 8000 Owner Contractor PGA WEST RESIDENTIAL ASSN. INC OWNER ID G 54320 SOUTHERN'HILLS LA QUINTA CA 92253 JUN O4 2004 -------------- -7 Structure Information --- - =---- Construction Type TYPE V, -,NON RATE CiFIN AN EDEPT.A Occupancy Type . . . . . . DWELLG/LODGING/CO <=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_aREPAIRS -------------------------------------------------------------------------------- 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 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: Applicant: Applicant's Mailing Address: Date: & - o q - o y Architect or Engine~er- G�u1S1� ! � Architect or Engineer's Address: & SCn �` 45 `Tato Lic. NO.: C1 ItSUILUING 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 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 s6le 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 in 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. , B.8 P.C. for this reason _ Datej-0 -4. b4 Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certifica(e 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' comee on insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ss ed. My workers' compens insurance carrier and olicy number aye -:;bb GJAT} t --14.J (.J Policy Number /.� p QS 4 4t '-A d 3 _ 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. r) ate (P'T . L01--11�,n �� r� IL / A 141- t 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 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. 1 certify that I have read this application dnd state that the above information is correct. I a ree 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 tioned property for inspection purposes. �efe gnature (Applicant or Agent): INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SIMPSON ETF. EXP. /1 -OS- HOLES DEPTH.CHECKED, BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION.AS PER ICBO 4945 .� LoC-S--ioc.c5 - 7.. 1��eT�-\ t �J �1 ��5' �Q7�fti Lc.J(a'•C� ��83) i� ��: 3��'�1.- ��cs-Ir%o��S. 12 t�t��"i►-t I"��A �y��S- �`t'�2 L�,Jc.;`-��/��iA 1u C-50 r-�O Lc S - 10 1 cP=tw l �J i �0�15 - 119 Z L t►Jc�'Cti-� S L± •, • AA 7=�YC�. •+rRci.S� k��17 y "ilavn Jt� rty�2il\J^2c 4W),*�i ! �JS�L�AZ�Ou� �L7r✓I J�c°T�"'� CIO rAtk% 710 TTLPA .,.,, b0ZN—=70S��►T��J Lo-r� ALL �r4�-�a�.,�,�.�c..�l�i�fl�a2>r +�,0Z) Osk�a-��l.-��o��Z. � �l \ 3 ALS c2 JUS �Jr—T-A . �, ►] h t . CERTIFICATION OF COMPLIANCE: To the best of our knowledge,. all of the rep substantially complies with approved. plans, specifications and applicable section! the locations of the work inspected only and, does not constitute engineering opin CERT. NO. 0859348-50, IVA • f DATE ISS O c 7,00 " 'Page -L a DAVE STEAVENS Inspection Services CT PROJE�l��A �J�ST-�a��.��z�cS PROJECT . ADDRESS Sy-= OQaI So�rvlc�2►J CLIENT f�C� A W� s T LLD DATE .1 S E- PT BLDG., PERMIT .# Q kA - %-4 a G I ARCHITECT . G o %-6 A- dr. C V4 ENGINEER \J,,:►� ,�► SP Jo K T�,J C- CONTRACTOR ac; VY�w• R. Ems- c.� c c.. INSPECTION TYPE INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SIMPSON ETF. EXP. /1 -OS- HOLES DEPTH.CHECKED, BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION.AS PER ICBO 4945 .� LoC-S--ioc.c5 - 7.. 1��eT�-\ t �J �1 ��5' �Q7�fti Lc.J(a'•C� ��83) i� ��: 3��'�1.- ��cs-Ir%o��S. 12 t�t��"i►-t I"��A �y��S- �`t'�2 L�,Jc.;`-��/��iA 1u C-50 r-�O Lc S - 10 1 cP=tw l �J i �0�15 - 119 Z L t►Jc�'Cti-� S L± •, • AA 7=�YC�. •+rRci.S� k��17 y "ilavn Jt� rty�2il\J^2c 4W),*�i ! �JS�L�AZ�Ou� �L7r✓I J�c°T�"'� CIO rAtk% 710 TTLPA .,.,, b0ZN—=70S��►T��J Lo-r� ALL �r4�-�a�.,�,�.�c..�l�i�fl�a2>r +�,0Z) Osk�a-��l.-��o��Z. � �l \ 3 ALS c2 JUS �Jr—T-A . �, ►] h t . CERTIFICATION OF COMPLIANCE: To the best of our knowledge,. all of the rep substantially complies with approved. plans, specifications and applicable section! the locations of the work inspected only and, does not constitute engineering opin INSPECTOR NAME INSPECTOR SIGNATURE ted work, unless otherwise noted, of the building. codes. This report covers Ln or project.control. DAVE STEAVENS CERT. NO. 0859348-50, t✓g • f DATE ISS O c 7,00 " INSPECTOR NAME INSPECTOR SIGNATURE ted work, unless otherwise noted, of the building. codes. This report covers Ln or project.control. DAVE STEAVENS