0402-158 (SFD)(V LU
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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
_777 699 B 4PNI/04
Date " I /" u Aignature of Contractor -1 l • ,
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.
( x)' 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.
1,1.17ERTY MUTUAL ,F.' W.A262L79f5�t'r723012Ti
(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: - + LVApplicant , j - ✓ L' '
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I•agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
� ✓ ff _
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Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE{ VALUATION LOT � 02,1,,'58 TRACT
JOB SITE
APN
ADDRESS
1
i31-350 G0LrJ VYZW.° M_ VE
'762410-026
OWNER
CONTRACTOR/DESIGNER/EN (NEER
' 0L L B1Z 113F_R8..WC
llym .:ll_11ar&MR111 WC
73=12.113`! WAFMG• #100
3.12.1 F?M PfrAAS3A4 CY 410
Pr'►LM DI IART CA 9126(5
PlUM DE"WR:C CA. 92260
(760>674.9699 CBMA$ 3832
USE OF PERMIT
Std • LOT 26, isR1:I:A.MG,14Tf?.A. FL1;.MIT 11093 NOT
11+1.AI IAS, P004 EPA Oil DORM tiWAY APPROACH
N��& �t
�01
iI
CUSTOM W1"dS`rRUCTION 3,94700 SP MAS
0 2 2004
."xk CITIr
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�1ayfp�l�:fp:,(�'3�1:�P(./�''��.`i'eyC9.}�qWe£¢i], �0y}ei;
4.'"Y"�"'
X 571 AIXD C osr OF C0N10VI JP,:'1:2t3N
331,,061M
plael"W1' FEE 114r.Ewl"Ry
COI S'1 RU CTIO14 FEE 1.01.000418.000 WA 16150
PLhN CHECK 4TEE 101-000-439-311 4.I,IQ9.li
UM!-, HAINCAL F92, 101-000-421-000 WNW
'LEC"TRICL Vii✓ 101-000-420-0(X) $203,69
P9..UM1s114e3 QBE 101 19.(100 t1ftoo
S'TR(..*10 MOT10N ''FZZ .'PMID 101-000-2411 -000 $32.19
ORADINO FRE 101-000-42'4-000 415100
DEVELOPER. IYd PPjr-''T FEE, 12,405.00
ART IN Fit BVICY PLACES - i2EME 270-000-445-000 $304.70
MR -TOTAL C-098MUC110INT .A3e1 O I�I�.tAAyy3 4yy"D M .�+�.�
$5,868..tt�I0
qq;ry7
WrAll FE'WNnYV'EFS DVE IV'€fi4w
iC+ 1,30
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs---i
zt, 4 tj 44
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
/-I
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
Final
BLOCKVIIALL APPROVALS
P®®LS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
If
Waste Lines /8 p
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/ /j
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
7tZ7ov
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 14447525321 GOUVIS ENGINEERING
PAGE 01
raii-g-i�-w.
June 14, 2004
Andy Fraser
Toll Brothers
73-121 Fred Waring Drive, Suite 100
Palm Desem 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 obsersf the structural requirements that are visible during construction
at the time of our site visit
Gouvis Engineering believes that the as -built const(4ttion 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. (6clusions 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 outliner and is neither a guarantee nor a warranty, expressed or implied for other trades or
requirements of subject dwelling.
Respectfully Submitted:
GOUVIS ENGINEERING CONSGLTING GROUP, INC.
Christina Silva Magdy Yacoub �3
Y.P. Construction Administration
949.7.t2.1(! 12
.. •fdOq tI�t,ln,i I lrivi
CA
1 c rl
J5'1Jfdd1
� No. C 37201
*xp.6/30/06
22 2001
1'31111 Sitrin1;;:, CA I'l�;t�'mun, l.;:1 Sacr:nttCnin. CA Sail Uke i *ilv, Ul' 11„ C:Iti aji:1), Cit+, Violi ut