SFD (0306-080)LICENSED CONTRACTOR DECLARATION
J 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, 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. Mworkers' compensation insurance carrier & policy no. are:
Carrier {.�I'i�i�i3i;,1 TOAIF Policy No. 4WAX D0041,13012TT
(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.
•D"ate: 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, indemnity
& 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.
re (Owner/Agent) Date
BUILDING PERMIT . PERMIT# 060 . )
DATE VALUATIONgyWj� j y�11� ra� LOT. I0. TRACT .211;rt1�9-3
JOB ADDRESS 01,--= 1t114i .I.fYir TJ> �r°ITAIAG
APN 763.x-410.0 Lai
OWNER
CONTRACTOR / DESIGNER / EN (NEER
`.� 1 L FsROT9..:2MW INC
a OLI.-BR.O`IiJEFLO bl '
`p3,.12)FIR" W.WN 14100
PPIM'IDIU T e.�'.A. 92260
Ptf6I..�:IM13MT CA 9°ti?'V-,.D
ka 0)674-969) 011h* *141,47
USE OF PERMIT
"12401 i+:ttia!4�L1' I1i1� :1.! i�3C3
�
fNpr_, • 17 ! Ui7.li '? d.F# 4l:AK•4. t',C� 3i, 0.f L�� ,^iV ti, ,:lq 4,t+ '` ASM a.tw .
VrAFtid% POCALt SPA. OR 7RIrLWAY MI?tiI-CH7S,16RM1"ON o 41AN
CHECK t;VZ } P, 0 MU_,LR1P_'ZYOF AFt1+Y111ly
IS a
CUSTOi•a CONf33'RUCTIU,Iv
iFrJI:.!",'I- hIATIQ - >14,u0 SP
(JARA.t.4I'tC,AFPORT :.0.11fi Sly
.T ) COUT OF
�yy�p� y� 7,ry •};p ,� yXnLAI
.���edLtIXlI i"ll sII. 9..:�.F LL7,l�T. it
Ct:YWSTAITCTTON FEE i 01 •tl; —418,000 911.3 oa '
PLA04 CHECK �L;1 101-(tebsl-43 1 � i I $� 78, I0 '
MEC.fI~ti'IK Al,FF8 ol-000-421.000 511331111 •
EL,ECT.RIC&L,'FIMF:
FL1,1Milird 1ti�$ it11^AGo�,I,II-wo •;;'• Si�O;fH!
STi2ONO R11%Z7'I00 FF r R&NIo`'.2 101-060-9,41-003 f ' $31.06
2:-1R.ADINCIWI; iti•^C�t•�°r3�Wrtt3 S1S.00 '
tR_?V L0PRR E111PACT: FEB �12;AOxi.CO
RTIN P13111.IC RAMS • FIE.111270-G00.4.45- 0M)
13MR—UrZAT C1 1.1, ICK
:Ini4 SER ;t.1�}
JUN 18 1003
CITY OF -LA CUINTA`' :;fir J
FIN/INCE DEPT.
RECEIPT DATE
BY
DAT FI ALEDINSPE
UOR,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
t' 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 3
Compressor
Insulation Q
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail 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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping — • 'es
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection / CD
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)
e �,-z -Z, 5 -
February 16: 2004
Andy Fr -ACL -.r
Toil Brother -
73 -121 FredWaring Drive, Suite 100
Palm Desert, .Ca 92260
Re- Muirlield at PGA West
Gf.LG Job#60368
Lo-. 10
Lo+ 8
Lo: 7
Phr.se
Dear Andy F.-aser,
This letter acvises that we have observed the structural requirements that are visible during construction,
at the time c f our site visit. �
Gouvis Engir:eering believes that the.as-built construction at the time of our visit is in general
conformance with our structural plans and rel@va.nt correspondence issued by our office relating to :he
�1 above refw*-iced dwelling.
%4-31 -
We observe z) the building in its framed condition prior to inatalletion of drywall and stucco. We observed
the visual and accessible structural requirements. (Exclusions are items such as: size of footings,
reinforced s+'eel in the foundations and roof sheathing.)
This report : s 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 clements
(as above ovdined) and is neither a guarantee nor a warranty, expressed or implied for other trades or
rL-quirements of subject dwelling.
Respectfully Submitted:
GOUV%IS ENGINEERING CONSULTING GROUP, INC.
Cliff Hattar Magdy Yacoub
Director, Fi,)ld Operations
v^.'..7_,_..'. i
L0 39Vd
CA Plr.ix.!nluFt.CA saci-aweiilo.CA S:till.A.t.(..tl,, I.r,i:hip9it,!i(.ilv,V:rin:ut,
SIAnoo TZEGZSL606 TT:ST b00Z/6Z/Z0
04/26/2004 10:.26 9096868786 WESTERN INSULATION PAGE 07/07
WESTERN INSULATION, L.P.
4211 Latham Street; Riverside, Cel 6mia 92501.
Tel. (909) 686-8760 Fax (909) 686-8780
CF6R INSULATION CERTIFICA'T`E
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH.
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT-
TRACT/PHASE: MUIRFIELD @ PGA WEST I PHASE 1
LOT#: 10
SITE ADDRESS: 81-225 MUIRFIELD VILLAGE, LA QUINTA, CA
------------------------------------------------------------------
CEILINGS: BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 11" R- VALUE: R-30
EXTERIOR WALLS: BATTS
MANUFACTURER. JOHNS MANVILLE THICKNESS: 6 3/4" R- VALUE: R-19
GABLE ENDS Ili PLUMBING BAYS BATTS
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 112" R VALUE: R-11
GENERAL CONTRACTOR: TOLL BROTHERS
BY:
TITLE:
DATE:
INSqLAMON CONTRACTOR: WESTERN INSULATION, L.P.
BY:
TITLE: PR C O .MANAGER
DATE: APRIL 26, 2004