0402-165 (SFD)�)
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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
777699 �f B i ;, 7 f�� L 4/30/04
Date 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 "tot 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.
(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: 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, 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 PERMITk
DATE VALUATION LOT 4)}02,.165 TRACT
2-8838-.14
JOB SITE • -.
APN
_
ADDRESS
OWNER -
CONTRACTOR/DESIGNER/EN INEER
TOL I , BOYD819C,
TOLL f3?' UI -D "WC
'?3.1`2"1. '�'K-0 .�i�'��.12E� 0100
73-',21 FMID NYs�R?4C�#,_1G�i
PALMI ESU—z CA 92260
:t:'A MTy. II'ia CA 9226.0
060)614-9699 COO 3832
USE OFPERMIT
SINT XE SjWp ] NELMNG
l
PERNI'T DOW riCT IWCt✓UDE
EILOCK WALLA, POO,% 3PA OR LDRUMANI APP11OACH. /5% 12
TO PL.AN Cd 1ECK FEE DUE TO MU1; 1FL OF aAt&z T �'�� Fn)]-
3SGUA14C;E � t�'
m
C°GxL'1'Dt�f rv'�,�IqS�'1;13CTiC)id 4,3'F9.00 3F
R 0 2 2004
POIiMFA'Y Iii 650.013 `'
OMWITUCARPORT '130,04 4�F CIT
Y OF LQlSINTA
P
NANCA DEPT.
E r�A.et'.a RIND COW'OF CiDiTI'sV'.L��y.71L`.daC3.F+7r
:4a4,687,150
CONSTRUCTION F95 101-000-418-000; sh;?63,50
1};v,NU CHECK M 101.000-439-318 $315.61
MECHANICAL FRF 101-000-421.000 $156:,50
�.rggggRyy3CAL FEE101-000-42(0y-O00 �a/�rq��
.
FILUM
FILU.Si'�'�1NO .7'IR 101-000-41-000 a'� 521100
ST FLC7:tdf3 hiOTF.ON 1LE- RMS ID 10"1.000-211->; DID $36.37
OILATaI'NO 1<1EF 101_000-4213 -000 915,00
1'9EVEL.[ PER IMPACT Y!`E $ti,405.t3it
ART 11.64 PUBLIC PLACES - RESIC 2.70.000.14;5-000 W40122
S9a-rfOTAL CON `MIt.TCTIOAi AND PIAN 4..HEC K
;Cs,321'.89
=31 .PRE -PIM 1< M
$0.00
TOTAL W FEES DUE :I•7OW
RECEIPT
DACE
BY / !
DATE FI ALEJD
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
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 g
F.A.U.
Framing
Compressor
Insulation a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final Z
POOLS a SPAS
BLOCKWALL PPROVALS
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
lumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test / Pi
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)
611
JUL-14-2004 10:17
AMAIt
TOLL BROS PGA WEST
760 7771596 P.01
GO UVIS ENGINEERING 4
G R O U P O F C O M P A N I E S
DATE: -T--� _ e*1 A --
PAGE j F
PROJECT NAME:14
Q4-- WAT1j __ JOB ti: 16
LOT # PLAN # CLIENT NAME:
NOTES: WT. PERSONNEL,
❑ INTERIOR ❑ EXTERIOR ❑ FOUNDATION ❑ ROOF ❑ INTERIOR & EXTERIOR ONLY >'RE -WALKS
Superintendent -ttsiy�.�^'► �.__....._......_,. .
Time in :: . Time Out
GOUVIS ENGINEERING GROUP OF COMPANIES WITH OFFICES IN:
4400 CAMPUS DRIVE. SUITEA A • NEWPORT BEACH. CALIFORNIA 92660 • (949) 7524612 • FAX (949) 752.5321
2150 EAST TAHQUITZ CANYON, SUITE 9 • PALM SPRINGS, CALIFORNIA 92262 • (760) 323-5090 • FAX (760) 325.3863
FIELD OFFICE: PLEASANTON (510) 206-9159
TOTAL P.01
DESCRIPTION / CODE
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Certificate of Occupancy ,
jI xc..R�FQ TMNCCIR 44
FT9► Y p Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 81335 GOLF VIEW DRIVE
Use classification: SFD Building Permit No.: 0402-165
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
Owner of Building: TOLL BROTHERS Address: 73-121 FRED WARING #100
City, ST, ZIP: PALM DESERT CA 92260
By: G. HARTMAN
Date: 12-1-04
Building Official
POST IN A CONSPICUOUS PLACE
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