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04-4292 (RER)ti- �.°' � u��cv � oz BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 ` (760):777-7012 CE OF, 9ti' 78-495 •CALLS TAMPICO ` FAX (760),77.7-7011 LA, QUINrTA, CALIFORNIA 92253 ` INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number t_04.70.0004292. '�Date 5/17/04 Property Address 54203 SOUTHERN HILLS APN: <. 775-101-046- - - Application description REMODEL -:RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation . . . 8000 Owner Contracto e --------------------------.----_--- fl - -- - PGA WEST RESIDENTIAL ASSN. INC OWNER 54320 SOUTHERN HILLS JUN Q4 2004 LA QUINTA CA 92253 ---------Structure Information - _-- =r4 OF � DFT. ---- 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 BUILD1NG'.PERMIT', Additional desc ; Permit Fee 99.00 Plan "Cheek Fee 00 Issue Date Valuation 8000 Qty Unit..Charge, Per Extension- BASE-FEE xtensionBASE-FEE 45:00 6.00 9.0000 'THOU-13LDG`2001-25,000 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, 99.00 Plan Check Total .00 .00 00. .00 ,Other Fee.Total 80 00 00 80 Grand. Total 99.`8.0 .00 1 . 00 , 99.80 f . 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 • L4,7Lj�2 Date: Applicant: chitect or Engineer: n Applicant's Mailing Address: Architect or Engineer'sddress: (oSIQ CA 13 1 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 Clais License No. Date Contractor, ' i 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 Atha 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 stile 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 turden of proving that he or she did not build or improve for the purpose of sale.). (, 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 n' e Date Lit `�" • C 4 /er 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. M &orkers' compensation 'in ura nce carver and policy number are: �drner �7tpt'I h 1 wr�7 /PolicvNumber 1 O c7 S `�'�'• dl1 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 shouldbecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. / W63 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, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or om;ssion 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 1 have read this applicatiori and state that the above informaticn is correct. I agree to comply lVith all city and county ordinances and state laws relating to building rt construction, and hereby authorize representatives of this county to enter upo the bove-ntioned pr for in on purposes. �3te Signature (Applicant or Agent): Page of DAVE STEAVENS Inspection Services PROJECT t' CLIA L I+cST=i'-,A.ttc S PROJECT# ADDRESS s`i-203 . Sou r�r�2,J,' 1��5, CLIENT - ((6N LA 4 -"1T -A CA. ...DATE a9 �ru0D BLDG. PERMIT # O 4 - 4; 9 J_ ARCHITECT C> A. t4 ENGINEER��) S�J�►c �",,IL CONTRACTOR'�NC_ S INSPECTION TYPE INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SIMPSON ETF. EXP. �D S HOLES DEPTH CHECKED,, BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945- �'_ f?�% ��.:� �' oZW�S 'i�o��3 •.1�. �1r�T� � DiR 1<J�- I� LLr.�(oTw1 � .Di�P ) LOLIS -'F-�0t-05 - t2 �c�'ir1-1 l0 2 LA -1 R UL -5 T-121 P, m a2DW.;t.ct{ TJS��c>,.z iD.J CO r-% ►'��.crc.. A,-LL-(2c7t�� J>rP� ��-S �-i. C.cP , . �' Iai T ' .`� oo.r �RAyr��cJC� %}AdZ�JuJf�2r..JS�wL�a ��,J .1ZJpF'��LZA1�: Ay�L� �#\x.10 b'coM*U4� - `�� E �.T C Z 'o iZ- L P< -r- yA _ C t. rTMJ S 3 �f�mi,!\�, f4�A�tiJ+�2� �,� �TkO n�. S4i�f��Z EZJ�� P�.: i Jb cT�'. .'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 Print Clearly) DATE `'lP / -2- S- INSPECTOR SIGNATURE