SFD (0306-073)LICENSED CONTRACTOR 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 # Lic. Class Exp. Date
Date r ' �` Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
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'
compensation, as provided for by Section 3700 of the Labor Code, for the.
performance of the work for which this permit is issued.
(Z,/) 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 insurance carrier & policy no. are:
Carrier I.i'gt8T.T':' ►� UTUAAL. F. Policy No. ''Bt'•.i��?kiIDNI9 dV1. UTF;
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 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.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety.
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
PERMIT #
BUILDING PERMIT
DATE VALUATION Ry ".•�,:+iq�:1D LOT. �., TRACT
Lp6''
JOSSITE �b�'14�MZIf .I'rI 't�1.�LdtLLF
APN 762�100-GXI3
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
11`C M 137Kai' limi s J?iG
'i' "LL-xMY.'"IflaZZ3 DIC',
3.121 T'i,TM WAM3:10. k11 W
71:2) -121 MIR'� 17,IAR[NC 013 110
PALM TAU. KW C 91260
P14a CA 92260
USE OF PERMIT
•
E��)t.+xsi '. 9d. �: .N�l xrlr. S.i Tl�J4:'S�.. .
otiA~Ld �lyTi
e�,+r.-h-ira CnS7?y.: ,ry.�ve ��•1i1.���tF..g, pui�ilfl�ytl �7y:N♦�r..tptJ'
fY.�lfl.ait� YV00"- 0PA 070 V+SU SNAV,'f?1C�,i�AMN.l7.1.H
t L1Tt1 :C)Ai IE?:llt" � 2d 3;���`,�►�SP
PORC.iIIPAT.Y) 3aI.t'A Sy
.F:��$�J19. il.•? R. A.i 'Nr�wi�. or com13.a 'b.i''4 6 cr-.i
VINAYI.T11"XX SUMMARY
iaCGAXIC:HEIrF:'WX 19-1 %� t,isE+3.21
MEt'1 NNUC'AL ? t 0.,000-421M000
ar :ECTPX1A.(w FEE � tA� • c��a��a��tft; r.a��.;��
s,i>i►iY�}I CI;:YH .till-O(V-4.19.000 SIAL 00
S7;'.f Yr 9 ::Mt3TiYrN J? r 1K:&.zb 101-000-241-0.06 $32.19
�3f't�d.Ci�Is3c3 �1'>it; ? �i1 •C-�tit?w47:3'-C1(7e� �9�.4zs
IMPACT
ART 04 P1,,13LIC< PLACES - R&HiE 2',70.000.44.1.OUa $W170
C 0N' 1-R'0*::'U0N AM MMi cM—Wir:
A\
C'MAXI FERW1%r :E'EV16 O 7 . NOW
$5,11 ux t
JUN 18 1003
CITY OF LA QUINTA
FINANCE DE".
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing —
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 2
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
%. G O U VI S ENGINEERING
CONSULTING GROUP •
E-MAIL TO • SUPPOR7Cf GOUVISGROUP.COM . SALES@UOUVISGROUP.COM
October 13, 2003
Todd Smith
Toll Brothers
73-121 Fred Wr►ring Dr., #100
Palm Desert, CA 92260
Re: _Muirfield at PGA West
Lot 3�
Lot 4
G.E.C.G.60178
Dear Mr. Smith,
•phis letter advises that we have observed the structural requirements that are visible
during construction at the time of our site visit.
Gouvis�Engineering believes that the as -built construction at the time of our visit is in
general conformance with our structural plans and relevant correspondence issued by our
office relating to the above referenced dwelling.
WC ubserveJ the building in its framed condition prior to installation .of drywall and
stucco. We observed the visual and accessible structural requirements. (Exclusions are
items such as: size of footings, reinforced steel in the foundations, roof and top plate
splice connections and roof sheathing).
This report is understood to be an expression of professional opinion by this engineer,
which is based on lois best knowledge, information and beliefs. As such it consists of a
report for only structural elements (as above outlined) and is neither a guarantee nor a
warranty, expressed or implied for other trades or requirements of subject dwelling.
Respectfully ubmitt• :., R �',.e�°^"^� �>., ,;_, ,
Gouvis ngineer) onsulting Group 4"r r� °Sr' r'r'="�` x,
6F..'-�t 3/31/05
4a6e.Oa . C / V 1 a'
President ` l' C) p�� r(
;''w�-_ F CALIF._
COUVI.c F1V7:INX&G GROUP OF COMPANIES WITH OFFICES TN -
4400 CAMPUS DRIVF, ;F, NEWPORT BEACH, CALIFORNIA 92660
2150LASTT4HQUI77CANYON, SUITE,9 PALM SPRINGS, CALII'ORNIA 92262
S,
ny Vinoya )
ect Manager
WEB-SITF: H7TP11WW1Y.60UVISGR0UPX0M
(949) 752-1612 • FAX(.949) 75Z•J1Zl
(760) 313-5090 • FAX (76q) 325-21163
PI>~LD OFFICE: NORTHERN CALIFORNIA - INTERNA'rIONAL OFFICE: VIETNAM
TQ 7r1H.1 CTAfn[1 T7CC7C1 rbr, PM :1 T PQC17 /CT MT
GOUVI,J ENGINEERING
CONSUL T .I N G GRO T I p, I N C.
October 3, 2003
Todd Smith
Toll Brothers
73-121 Frcd Waring Drive, Suite 100
Palm Desert, Ca 92260
Re: Mutrtield at PGA West
Revision
GECG Job No. 603hR-210
Dear Mr. Smith,
Pursuant to your request regarding the above captioned project, we submit the following.-
Due
ollowing:Due to the electrical panel occurring at the shear wall on the side of the garage of thr Plan 3884, add
shear to the inside face of the wall as shown on the attached page.
Note: Please verify the above with the building department prior to construction.
If you have diiy 4ucstio115 please do not hesitate to contact this office.
Sincerely,
GOUVIS ENGINEERING CONSULTING GROUP, INC.
Christina Silva _
V. P. Construction Administration
Attachments (1)
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ti Q� 0 3 1003
s1.� cIV
IF Of CAMs
COUVIS ENGINEERING GROUP OF COMPANIES WITH OFFICES IN: WEB -SITE: WWW.COUVL4GROUP.CUM
4400 CAMPUS DRIVE, NEWPORT BEACH.. CALIFORNIA 92660 * (949)752.1612 • Fox(949)752-5321
:IA E. TAIIQ0I72 CANYON SL?TK 0, PALMSNu1NCS, CALIFORNIA 92262 ` (760)323-5090 Pea(760)325-2863
FIELD OFFICE • PLEASANTON ' INTERNATIONAL OFFICE: VIETNAM
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