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BOTH2017-00174 aw. 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: STRUCTURE OTHER THAN BUILDING/ Application Number: BOTH2O17-0017 Property Address: 54000 PGA BLVD APN: 775080004 Application Description: PGA WEST / ENTRY MONUMENTS AT 54TH AND JEFFERSON Property Zoning: Application Valuation: $375,000.00 Applicant: LRTMENT STEPHAN STEPHANOFF49499 EISENHOWER DR LA QUINTA, CA 92253 OFLA'RTMENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is irrfull force and effect. License Class: B License No.: 968718``'' ,� 1 Date:Cu;t1. 11, A cit'o'ntractor. IAU/f— OWNER-BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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 the applicant to a civil penalty of not more than five hundred dollars ($500).: (_J 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 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.). ( )1, 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 this reason Date: Owner: 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: VOICE (760) 777-7125 'FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: V 1/17/2018 Owner: PGA WEST MASTER ASSN INC P 0 BOX 1578 LA QUINTA, CA 0 Contractor: VINCERE INDUSTRIES INC 73-983 HIGHWAY 111 PALM DESERT, CA 92260 (760)904-4120 Llc. No.: 968718 WORKER'S 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' compens ion, as provided for by Section 3700 of the Labor Code, for the performance of the r for which this permit is issued. ave and will maintain workers' compensation insurance, as required by Sectio 3 0 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9206351 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. I 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. APPLICANT ACKNOWLEDGEMENT' IMPORTANT: Application is hereby made to the Building Official 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. I certify that I have read this application and state that the above information is correct. agree to comply with all city and county ordinances and ws relating to building construction, and hereby authorize representatives of cit�.to ter upon the above- mentioned property for inspection purposes. Date: 1/17/2018 Application Number: BOTH2O17-0017 Owner: Property Address: 54000 PGA BLVD PGA WEST MASTER ASSN INC APN: 775080004 P 0 BOX 1578 Application Description: PGA WEST / ENTRY MONUMENTS AT 54TH AND JEFFERSON LA QUINTA, CA 0 . Property Zoning:. Application Valuation: $375,000.00 Applicant: Contractor: STEPHAN STEPHANOFF VINCERE INDUSTRIES INC 49499 EISENHOWER DR 73-983 HIGHWAY 111 LA QUINTA, CA 92253 PALM DESERT, CA 92260 (760)904-4120 ----------------------------------------------------------------- Llc. No.: 968718 ---------- Detail:.TWO (2) ENTRY WATER FEATURE MONUMENT SIGNS WITH FIRE ELEMENTS AND SITE WALLS WITH PLANTERS AT 54TH AVENUE AND JEFFERSON ST ENTRANCE TO PGA WEST [ENGINEERED] THIS PERMIT DOES NOT INCLUDE LANDSCAPING APPROVAL OR GAS AND ELECTRICAL SERVICE . INSTALLATIONS, EXISTING TO REMAIN. 2016 CALIFORNIA BUILDING CODES. FINANCIAL •• /. DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - ESGIL STRUCTURAL ENGINEER 101-0000-42600 1.5 $180.00 Total,Paid for BLDG CITY STAFF - PER HOUR: $180.00 DESCRIPTION ACCOUNT QTY AMOUNT RETAINING/COMBINATION WALL EA 50LF 101-0000-42400 0 $46.80 DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - EA ADDITIONAL 50 LF 101-0000-42404 0 $78.00 DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF 101-0000-42404 0 $52.01 DESCRIPTION ACCOUNT QTY AMOUNT WALL/FENCE - FIRST 100 LF PC 101-0000-42600 0 $65.02 Total Paid for BLOCK WALL: $241.83 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $15.00 Total Paid for BUILDING STANbARDS ADMINISTRATION BSA: $15.00 DESCRIPTION ACCOUNT QTY AMOUNT OTHER ELECTRICAL EQUIPMENT 101-0000-42403 0 $52.02 DESCRIPTION ACCOUNT QTY AMOUNT OTHER ELECTRICAL EQUIPMENT PC 101-0000-42600 0 $52.02 Total Paid for ELECTRICAL: $104.04 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $13.00 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $26.01 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $13.00 DESCRIPTION ACCOUNT I QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $13.00 Total Paid for PLUMBING FEES: $65.01 DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE - MAJOR 101-0000-42416 0 $20.00 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: .$20.00 DESCRIPTION ACCOUNT QTY AMOUNT MONUMENT SIGN, EA ADDITIONAL 101-0000-42404 0 $26.53 DESCRIPTION ACCOUNT QTY AMOUNT MONUMENT SIGN, FIRST 101-0000-42404 0 $78.02 DESCRIPTION ACCOUNT QTY AMOUNT MONUMENT SIGN, FIRST PC 101-0000-42600 0 $143.56 Total Paid for SIGN: $248.11 - DESCRIPTION ACCOUNT QTY AMOUNT