0402-160 (SFD)1, \
CA -.
H
N U)
w
O =) ch
w
oZr-
C) 0. o
HC.0
�a�
W
Z
co
LO
N
p N
U °'
CL Q
Z
Cr
Lo
xw�L
m<0
d
rnH
Iq Z
ob 0
a
Q
J
LICENSED CONTRACTOR DECLARATION
!,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
777699 P. 4130/04.
{/Signature of Contractor I {
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 Policy No.
111BERTy MlI°F1IAL Ir WA262DO04=012TI;
(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: / - t�Applicant 7,`•e 1
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. r
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
ariy 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) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0402-160 TRACT
23 2�I�33�3.3
JOB SITE
ADDRESS
APN
�3 q �� �Vl1q ems. yyy Tlg� y
E 1-'wo S,.`'L)JjS__ �ldt YW sIGSI PA:.
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
INC
'('CfL,Z., BRO`ams We
75-121 .tai vTmwo SRI oo
73.121 WAIRING 0100
PAZIm 13FS:C=:T�.`.0 CA 9226th
PALM D09 ?RT GA (122£4!
C/60)674.9699 OSLO 832
USE OF PERMIT
ffiN J'—T T? RP 5UZ Ti�N.I�:.i:J?10
SPO -1,OT 2,% SANTA. RO-U A.Wpado PERMIT DOE'S NOT f1NC LUOP,
BIXI K WALI 3, P004 9PA OR WFLI tRWAY APPROACK 75"/. REDUCTION
TO PL,A14 CHECK FEE DUE TO AIULTIPLEV,.ISSUANCE OF SAME PLAN -
OVSTOM CIDYWRIXTION 3,741.00 Ski
PORCWP.ATIO 4,14.00 MF J MAR
02 2004 �
t" 1ARACIFICA.WPORI 736.00 SF
CITY
' F LA OWNTA
FI:
LiNCE DEPT.
ES'D' I'E:ID COST OF Od)NN.I Td17CiTON
31.2,146,E
CONSTRUCTION AIE 01.000.418-000 $I,3tK6►t)
PLXH CHECK K FEE 1101 -WO -439-318 S.rP.45
MLrC`.I'iMIC.'.WwIEEE 101.000.421.000 Sa118.00
LF. , RIC'AL, FEE 201-000,420-000 $102.06
PLOM 14INt3 Fid 101 000.419.000 S1gp,00
STRONG :1MOT101-1 FEE,. RESID 101.000-24.1-000 $31.21
CRAWNG FEE 101.000-423.000 $100
DEVZLOPER IMPACT FF -R.
ART IN PUBLJC PLACES - IMME 270-000-445-000 $280,37
SUIS -TOTAL OONSTRI=10W AND PL,AM (THr, CK
714,906.09
3 ppL'-P.AID F.K S
$0,00
�C ys it PTMVM . 'S DOEr NOW
�,5 ►.ED9.
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
Retum.Air
Steel
Combustion Air
Roof Deck
�6
Exhaust Fans
O.K. to Wrap_
p
F.A.U.
Framing
_e
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Z
Drywall - Int. Lath
Final
Final
BLOCKWALL A ROVAL
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
Sewer Lateral
_
_ _ _
3
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Q
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:
06/22/2004 03:35 19497525321 GOJVIS ENGINEERING
PAGE 01
GO -UN -1 S
('t1Ntil,r.?2!� 1..11x'.
June 14. 2004
Andy Fraser
Toll Brothers
73-121 Fred Waring Drive, Suite 100
.Palm Desert CA 92260
Re: Muirfield at PGA West
GECG Job#60368
Phase Z
Lots 24 through 28
Dear Mr. Fraser,
This letter advises that we have obser the structural requirements that are visible during construction
at the time of our site visit.
I
Gouvis Engineering believes that the as -built constfUttion 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 and roof sheathing.)
This report is understood to bean exprvession 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:
GOUVIS ENGINEERING CONSULTING GROUP, INC.
Christina Silva Magdy Yacoub
V.P. Construction Administration
949.7- 2.) 6 12
htr'Jh9.77,�.:i : 12' 1
,!•IqU (ter„l,n.; I lriF�
NOWIlor) Beath, C.A
No. C 37201
�0/06
2 I 211Qi
Pahl' Sl+r'iu1;;. CA GA Sacr:rn)cnlcr.0 A Salt t.,ikc•(:i1v,t1'f
I