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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
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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