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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Shapter b'(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
777699 5 4/30104
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.
( ) 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.K My
yfrtfl3 Js 1 compensation insurance carrier,,&.,poH no are:
Carrier Policy No. P.r�,�ez%u"is1Jl2'1'f
(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.
Date: Applicant
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),-4' lam`-•�' Date
BUILDING PERMIT
#
PERMITWin- 7. 2101
DATE f 4 - f. "7 VALUATION LOT
i TRACT
28838-2
JOB SITE 6.1-173 , i1MFUMD
APN ` ..
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TOLL NZ.0VE21 RIJI WC
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USE OF PERMIT
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PLAN CHWK FEE 101-000-439-33 .9
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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 i
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
Encapsulation ;
Gas Piping
Gas Test
Appliances
Final
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)
..-COMMENTS:
t
'
-
`
-
January 8, 2004
Todd Smith
'doll Brothers
73-121 Fred Waring !hive — Ste. 100
Palm Desert, CA 92260
Rc: Muirfield at PGA West
Lots ,and 6
G.E.C:G.60368
Dear Mr. Smith,
This 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
confortnance with our structural plans and relevant correspondence issued by our office relating
to the above referenced wc1ling.
We .observed the building in its framed condition prion to installation of drywall and stucco. We
I observed the visual and accessible structural requirements. (_Exclusions are items such as: size of
footings, rcinforced steel in the foundations).
This •report is understood to be an expression of professional opinion ,by this engineer, which is
based on ;his 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 Submitted:
00 En " n suiting Group
cccd ek;urt
President
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CA f'ic:� nu.��t. CA l:icr,mcnio. (A Sall ; ;il.0 ( :itv, l:'I' I to t :;,, h1in;i City. Vic nmi,
SlAnoo TZE5ZSL6b6 ES:bT h00Z/80/!0
UQtYb/ 'LbU4 'J'J'Jbk;bb lbb WEE ILRN INbULAULIN PAGE 02/07
WESTERN INSULATION, L.P.
4211 Lmalsam' Street, Riverside CaUfo mma- 92501
.
Tel. (909) 686.-8760 Fax (909) 6064786
CF6R INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTAL -LED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA., IN. -THE BUILDING LOCATED AT:
TRACTIPHASE: M.UIRFIELD g. PGA WEST I PHASE I
LOT#: 5 -
SITE ADDRESS' 81-175 MUIRFIELD VILLAGE,. LA QUINTA, CA
- --------------------------------------------------------------------
CEILINGS: BATTS
MANUFACTURER- JOHNS AMNVILLE THICKNESS: 11" R- VALUE: R-30
EXTERIOR. WALLS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 6 314" R- VALUE: R-19
GABLE ENDS &PLUMMING RAYS - BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2' R- VALUE: R-11
GENERAL CONTRACTOR: TOLL BROTHERS
BY,
TITLE:
DATE:
INSULATION CON -TRACTOR: WESTERN INSULATION, L.P.
LICENS UMBER- 794484
BY:
TITLE: PR IO MANAGER
DATE: APRIL 26, 2004