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04-4209 (RER)T4hf 4.fWQ" 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 . . . . Owner ------------------------ PGA WEST IJOA 54320 SOUTHERN HILLS LA QUINTA CA 92253 BUILDING & SAFETY DEPARTMENT (760):777-7012 FAX (760) 7 77-70 11 INSPECTION REQUESTS (760) 7.77-7153 0=4�ObeQ�04 09_ Date 5/13/04 55060 FIRESTONE 775-153-033- - - REMODEL - RESIDENTIAL LOW DENSITY RESID 1500 Contractor OWNER Structure Information D ' MAT 2004 CITY OF LA QLJiEz A FINANCE DEFT. 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 -------------------------------------------------------------------7-------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee 35.00 Plan Check Fee .00 Issue Date . . . Valuation . . . . 1500 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 2.0000 HND BLDG 501-2,000 20.00 ----------------------------------------------------=----------------------- Special Notes and -Comments VOLUNTARY SEISMIC STRUCTURAL REPAIRS ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - RES .50 Fee summary Charged Permit Fee Total 35.00 Plan Check Total .00 Other Fee Total .50 Grand Total 35.50 Paid Credited Due ---------- ---------- ---------- .00. .00 35.00 .00 .00 .00 00 .00 .50 .00 .00 35.50 P.O. Box 1504• �� VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 041- 14,101 Date: ri Applicant: Architect or Engineer: C-:?biF-- Applicant's Mailing Address: Architect or En Ineer's Address* 410Q D s.� . L,,n Lic. NO.: 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 700 0) 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 taa? 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 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.). (-.) I am exempt under Sec. , B.§ P.C. for tho reason n a WORKERS' COMPENSATION DECLARATION`S 1 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' compensati urance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Mxworkers' compensati ' urance carrier and policy number are: mere t7 t Ll n Policy Number 150 -5414-- a.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. f A n /1 a ,. I ,'-Date hel 10 J 4- 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 Lenders 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, indemnify 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. 1 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 tp ent r upon the above -menti property for'nspection purposes. ate i nature (A licant or A ent : �� 9 PP 9 ) .10h DAVE STEAVENS Page / of Inspection Services r PROJECT W> A W 4 S'C - G P-deQ5 PROJECT # ep o `f O ` ADDRESS II* -060 �r�- izerop.)C CLIENT P6A Lt)Cs'r f4 0A _ L A 0t,.wyA , (2-, BLDG. PERMIT # 04 - 14 ;1 0<1 ENGINEER I C t.t3Z SA J Dt t!; s, X, INSPECTION TYPE DATE 7 D G, T. .2 a a 9 - ARCHITECT &OLM 2 C� CONTRACTOR PFS C I INSPECTION REPORT FOLLOWING LOCATIONS EPDXY SIMPSON ETF. EXP. 3.O g- S* HOLES DEPTH CHECKED, BRUSHED AND CLEAN OF DEBRIS. APPLICATION AND INSTALLATION AS PER ICBO 4945 � LtXS I_Ld, 4S -0 (7.. .p-r.A � Dtt1. ZODS—i-7 t���Civ.► �� 1J�1�• IEry ; L-hrf" I�d�t' 714c-)- ►'[01.T.5' 2 bt?TA CD tA. SODS � 17'1Lx-r 6-n4 -7 /��� ,icr> r k % - 2— Q — Y 0 -b N A 1 lrl Csa `" Co W\ -'-�) u '"'`G^' w1 - co 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 W, the locations of the work inspected only and does not constitute engineering opinion or project control. CERT. NO. 0859348-50 DATE � 3 -"�12=-( .. .100* INSPECTOR NAME DAVE STEAVENS mtClearly) INSPECTOR SIGNATUR�'QaAJk.