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0207-009 (SFD)� W W • o Z r� coo O. o �CID www �a rn Z M LO N ON U °) CL g Z Lo ¢ O xUj�= C0 < O ll � co C) Q J 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 67,4185 B 05,"39/7( 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. My workers' compensation insurance carrier & policy no. are: Carrier 21AT_L' FLYAID Policy No. "11302009332 (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, andiagree that if I should become subject to the workers' compensation provisions. of Sectfb_n 3700 of the Labor i /1 Code, I sh/al fo with comply with, o e prove ns Date: �� 4"JApplicant .�!✓ ` �e Warning: Failure to secure Workers' Compensation coverage is unlawful and I hall 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, rep esentatives of this City to enter upon fife above-mentioned property(for,•inspedb'on purp6'ses. Signature (Owner/Agent) �+`��''4 Date f �� BUILDING PERMIT PERMIT# DATE VALUATION LOTQ% TRACT JOB SITE ADDRESS WW�n' ANY-YRL. OWNER CONTRACTOR/DESIGNER/EN INFER 625 DRT" A' Ni ?i3C1' S W1 53042 r ALM T'MeMT CA 9226.1 USE OF PERMIT VD, LAOT 31. PEIRMfT MA.`.f NOT YNCD. UDE BLOC3C.'WA.UA POOLsxam salR1")RIV EWAY APPROACH CUSTOM CONSTRUCTION 40.84.00 S FORCHI'PA'! TO 326.90 SF GAR,;AMIC ARPORT 1,:k7 oo 3r ?�"a'".�d7l�:AI't�'1✓ CONT O �{S?I�?lS`I;i.��'CM(IN 4.24, 1.20 y�,''��''11 /�.�qq. FRE ..T�RIT,WI ► c579RE WAR C°ONIT f1UC'•`1 ION FZ9 101.000.41 E-000 1'11 ,00 PLAN C. HTeCK FER 101.000-439••318 $1,447. 12 M?F DEPOSIT 101-000-439-318 411000.00 MECHANICAL M, 101.000421 -OW S1173,50 ltLECTRIC.+AL FEE 101-000420-000 $2821so P:,•tlMI INO PRY, 101-000-419-000 $141.23 " `k'RONG MOTION PIKE - i3UID 101 }-000.141.000 X92.0 ORADY-14 :3 MP. 101-000-4-23-000 $15.00 DWINUOPER rMPAtYT FKR $M05 00 .ART IN PU13LIC PLACES - ftSIE 2 0-OM445-000 $560.74 gL38-`TOTAL C!;C5NSKIMU=034 Al'J�7.3y�1;'tq.,a•�y�31 Cy�1"!ry�CK ,/953.'52 y��{� /-� 0 �,t SIS .Aluz_Yf�ilo �'.L1iC�/7 ,e� 4110no.00 D CRMEM 5^ JAN 2 12003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT BY DATE FINALED INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING'APPROVALS MECHANICAL APPROVALS Set Backs A 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�0� Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover _ Equipment Location Underground Electric Q711y, - IAIC70CACkr $;� e'p'� 1z3 a3 ✓ Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Q d3 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover ewer Connection Gas Piping Encapsulation Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas)�� ELECTRICAL APP OV 7 Temp. Power Pole -- Underground Conduit Rough Wiring Low Voltage Wiring FuQures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) l GOUVIS ENGINEERING • CONSULTING GR'O UP • E-MAIL TO • SUPPORT@GOUVISGROUP.COM • SALES@GOUVISGROUP.COM September 24, 2003 eco SEP 2 9 zoos Butch Procknow Strother Construction 1 Mirada Circle Rancho Mirage, CA 92270 Re: Bowen Residence G.E.C.G.60167 Dear Mr. Procknow, 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 conformance with our structural plans and relevant correspondence issued by our office relating to the above referenced dwelling. We observed 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 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 Su Group rresiaent r �. J SJB:SV:cb ; 092403a =` " S,EP 5 2003 rn ro I V �.. Sonny Vinoya Project Man ger Psi ` ::,. v.', v •l GOUVIS ENGINEERING GROUP OF COMPANIES WITH OFFICES IN: WEB -SITE: HrrP//WWW.000V1SGR0UP. COM 4400 CAMPUS DRIVE, NEWPORTBEACH, CALIFORNIA 92660 (949) 752-1612 • FAX(949) 752-5321 2150 EAST TAHQUITZ CANYON, SUITE 9 PALM SPRINGS, CALIFORNIA 92262 (760) 323-5090 • FAX (760) 325-2863 FIELD OFFICE: NORTHERN CALIFORNIA - INTERNATIONAL OFFICE: VIETNAM