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0402-159 (SFD)U) C14 O cY) �Lf) LLJ oZt� CD O' 0 b V] J LLIa Z Cf) LO N ON U M dQ rQCr 0 0 JJ co < rn H Z C) Q LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of f£hapter 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 ?77699 B 413OVO4 :f - I C � Signature of Contractor �' �' c , ` ` r 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-coristruct the project (Sec. 7044, Business & Professionals Code). () I am exempt under SeQtion , B&P.C. for this reason Date Signature of Owner j 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. LISL ITY MUTUAL F. WA262DO047= I2TI (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: - f '. C.' q pplicant -, f` , / Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes., _ Signature .(Owner/Agent). C '' f r'Date l- 1�1 T BUILDING PERMIT PERMIT# DATE VALUATION LOT Qg-i« TRACT 1 i I �,�.ts 27 -3 JOB SITE ADDRESS APN S134D VWN10N:0HIVE Q 7,6.Z-4.10-027 OWNER CONTRACTOR/DESIGNER/EN INEER TOLL BP,0'E-lr' . ZS CYC TOLL BR0T1M&14 :11+4C 75-121 ERM WRING -4100 73.121 FRMWARMG M 00 PIS I31✓.4W1: T CA 92260 PALM DF -11-01r, CA 12260 (760)674-9699 CBLO 3832 USE OF PERMIT 31FD s LOT 27, VtrNTA NA,-A/4Y�r=T& PERMIT DOES NOT INCLUDE DLOC� OML A P004 SPA OR, DRIVEWAY APPRO AC K 75$o l EDUCTRYK TO PLA14 CHECK FRE =9 `CO MTJLTI'PVF, INISUANC E OF SAMI'r, ..�_ CUSTOM CONSTRUCTI©N 4,374.00 SF P€?RCHPP ATIO ` 650.00 slr MAI? 0 2 2004 I U A.�'�iit'iCSFi�CA9,i'�i"OR `59.00 S CITE 000 -FLAK EAfTi'd FINANCE DEPT. 11:5rr.DAAt'L:i.1 COSIT O.;lt" €'11OWb"1 RUC110N :316.11 "i?.60 SL71l AURY CONSTRLICTIC3N YTE 101-000.418.000 SI,562,30 PLAN CHECK FRP: 101-000-419-318 $3I S.6i MECH"ICATI FEE 101-000.421.000 9156.stf VLF.a.TIRIC.AL Ful 101-Ct(X"20-0000 $200.69 VILI1F1J11a1N r LEE 101.OL10-4I 9-000 $213.00 STRONCI MOTION FEE - RESID 101-000-241-000 000 06.37 c341AlliAICi !ZL i Jl AC1C10�423.Oti0 31S,0J DP, .?1,OPXP IAIPACT FEE $2,4;iS.40 .ART cN PUBLIC PLACE'S - RMIC 270-000.445-1004 $409.22 STFB=I'OTAL CQNS-T_tTJCTf09 AND PLM CrV20K $5,322.89 LESS FFXX JW :0'r'L+.�T TOTAL 1XES DUE NOW RECEIPT DATE BY DATE FINALED INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts .Forms & Footings ucts Slab Grade Return Air Steel Combustion Air Roof Deck 7 Exhaust Fans O.K. to Wrap o- 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 Final POOLS - SPAS BLOCKWALL APOROVALS. steel Set Backs j 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 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 Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 06/22/2004 03:35 19497525321 GOUVIS ENGINEERING PAGE 01 V June 14. 2004 Andy Fraser Toll Brothers 73-121 Fred Waring Drive, Suite 100 Palm.Deser; CA 92260 Re: Muirfield at PGA West . GECG Job#60368 Phase 2 Lou 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. Gouvis Engineering believes that the as -built constfuction at the rime 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 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 Submitted: GOUVIS ENGINEERING CONSULTING GROUP, INC. CA /a. -c- v / n. 3 Christina SilvaMagdy Yawub V.P. Construction Administration 949.7'2.161 r,,s 949.7575. ,1.1000 <. m+ln+; I )riw I' .. Nc:wl,od 1',vn,:h, CA k No. C 37201 *_ zf3M6/ I'aIm I'll n in}::, CA Vlcas;!Iv u+I, (.;A Savramcnin. CA Sail Ukc l :ilv, UI' I i,+ L:hi '%1ia11 l it+. V tOlUll