9909-232 (RER)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
C ch License# Lic. Class, Exp.D y
LLJ 0,
oZ r- Date 5,r� Signature of Contractor-- ` -
CO 0
J U OWNER -BUILDER DECLARATION
Wfl I hereby affirm under penalty of perjury that Itiam exempt from the Contractor's
License Law for the following reason:
Z ( ) 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
c retractors to construct the project (Sec. 7044, Business & Professionals
Code).
I am exempt under Section B&P.C. for this reason,
—
U)
N Date Signature of Owner
O_ N
d Q WORKER'S COMPENSATION DECLARATION
o 2
cr I hereby affirm under penalty of perjury one of the `following declarations:
r H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W u' compensation, as provided for by Section 3700 of the Labor Code, for the
Om � C perto ance of the work for which this permit is issued.
Q U 1 haveiand will maintain workers' compensation insurance, as required by
O 'U Q S Ion 3706' of the Labor Code, for the performance of the work for which this
Il: LO H permit is issued. My workers' compensation insurance carrier & policy no.. are:
� z Carrier Policy No.
O `;'S'A'GE FUNP,
g (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 t0 the
workers' compensation laws of Califor ' d agree that ' should b come
subject to e workers' compensati prov ons of Se i n ,3700 oft Labor
Code, Ji II ith comply withfhose rro�
Date: Applicant
Warning: Failure to secure Workers' Compens'ati coverage is unlawful
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 applicator agrees to, &:shall, indemnify
& hold harmless the City of La Ouinta, .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 aut e r pregbfttatives of this City to enter upon
the above mentioned property f pectionpurposes.
/ .
Signature (OWner/Agent)•- - ` t Oate
BUILDING PERMIT PERMRM
_
DATE it OAfU -TION LOT TRACT
/ ! ?S�.ftf8 ?rr)
JOB SITE
ADDRESS -19400 CASA i`I����l�6.adi.i.E.
APN ir�6d �itta•tGIE7
OWNER
CONTRACTOR / DESIGNER / ENGINEER -
;fi:? ►,tr.`r1'!; )' 6�1:'.'):)..:.1P+n lcrrj j
SPA" �, S '70"'r oar rrrr cfti�r
1.-;A,s.Jt_Idy'+T!,k ("A 91.2'_)3
LAQL4N't"A f'.t1 02253 I
%M771.1941
USE OF PERMIT
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,�I.�It3 i'1'J'171 it t13 -LN :ft . A'3' s49.),iFi16: f;,*A 3iNU titdi ?i.4' 'sUl d•i'. ENTRY
NIK,.1r'MIraTED Ml'f Or C �Vi Thuc_ -1oiti'
41ii).Sel r
KAN (AfilEC;,hd FUE '.10 140)-439-318
t^. )W, ITRI It i`�t�A) FOR I f9 • f!tli)-4 d 'B t 4,fT7i
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RECEIPT
DATE
BY
DATE FINALED INSP TOR
'/i
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steal
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 8 Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS e SfPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI. Test
Final I
Gas Piping
[PLUMSHG APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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)
4 1
.i
G O U VIS ENGINEERING
•• C A L I F O R N I A@a •
ember 7, 1999 E-MAIL TO • SUPPOR7GOUVISGROUP.COM • SALE'S@GOUVISGROUP.COM
T.D. Desert Development
/o S arks Construction Y om.
c p
P.O. Box 1716
La Quinta, CA 92253
Attn: Nolan Sparks
Re: Montanas
Doering Residence
79-100 Casa Vida Circle
Parcel #16, Lot #66, Plan #1
GEC Job No.: 20505
Dear Mr. Sparks:
Pursuant to your request regarding the above captioned project, per our phone
conversation on 9/01/99, we submit the following:
Follow the attached partial framing and foundation plans for the added door at the rear
right of the garage, the added door at the rear of the master bedroom and the revised guest
suite entry.
Note: Please verify the above with the building department prior to construction.
If you have any questions, please do not hesitate to contact this office.
Sincerely,.
Saeed J. Bekam .
President
SB:cb
20505
Z
Mce 039276 M
A
Exp. 3/31 /00
� ymond Frangie
Cly %. -_ect manager
attachments: 8
GOUVIS ENGINEERIN GROUP OF COMPANIES WITH OFFICES IN: WEB -SITE:
4400 CAMPUsDRIVE SunEA • NEWPORTBF-wn, CALIFORNL! 92660 • (949) 752-1612
2150. EAST TAHQunzCANYON, Sam • PALM SPRINGS, CALIFORNIA 92262 . (760) 323-5090
5465,MOREHOUSEDRIvE SUITE 100 • SANDIEGO, CALIFORNIA'92121 • (858) 623-9941
FIELD OFFICES LAs VEGAS (702) 597-2005 • FAX (702) 597-0905 + FREMONT (510) 252-9195
WWW.GOUVISGROUP.COM
• FAX (949) 752-5321
• FAX (760) 325-2863
• FAX (858) 623-0278
• FAX (SIO) 252-9196
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