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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 13 4!30/04
DateSignature of Contractor' ` r
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).
( ) 1, 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.
(r) 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.
LIBERTY MUTUAL F.
'( A262O.f3t147 3012TL
(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:,,.- { ( /,-r /Applicant ) C, e .
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)` r ' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 04402-157 TRACT
$363,68 7,60 25 - 28838.3
JOB SITE
APN
ADDRESS
#1.-360 GOLF VLEW URY IO.'
762-14,10-02-5
"'
CONTRACTOR /DESIGNER / EN (NEER
M1111 IMOTITERS INC
YML L BBOT EMRS WC
73.121 IM VIIt�R- MY4100
73.121 FftW'kXAR1W0 #100
PALMDRSYWr CA 922.60
VALM DL7SERT CA 922.60
(760)674-9699 MR 5342
USE OF PERMIT
S1 iCT.I? �3i L. Dv/mlzlo
WD - LDT 25, rENTA14.iL.V4*/Cfl:sta. P1::n.Aha icon i4oi, l[+f4'•X.LIrD
D,,WCK WAC.W, !'.004 SPA OR ORNEWAY APPROACH
Fnn
/A, ,�
CUwTOM CONSTRUCTION 4,5"-4.00 SP r PAR
0 2 2004 1L111
PORCWPAT10 00.00 SFS
C1F1RAl3UC.A.'RPORT `i30.0e SF r,Y
FLA 4UENTA —
i
JUANDEPT.
XSTIINl1l" ED ta03 (�11 M1+7817111C'1' ON
CONSTRUCTION FEE 101.000.418.000 $1,563.50
PL ,/ 14 CHECK FEE $1,762.45
MECHANICAL FEE $1500
ELECTRICAL, t'�" •i; 101-000-420-000 $208.69
PLUS,§MO F9K 101-000.4.19.000 32130
:1TP.CNCI MOTION FEL - RESID 101.-U(DL'-2� 1-000 $36.37
C+M.DINC RIE 101.000-423-000 $15.00
13T l'�U,O.PY,R IMPACT ice• $2,103.00
ART 1N PUBLIC PLACES - R&31r r/0-000.445-000 34409.22
SUB-1'0.1AL COR+313'i'F217C'TI0.14 Y11k1.T� Pi" CHECK
$6,269.73
120'a PR-PAWYEPO
$0,00
l'DrA:LC :i'3, ;¢'�1431!°f' FEES VVE NOW
&6,26%,73
RECEIPT
DATE
-4 1 / - r,.c /
BY
I,Gf! X•
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
y
Underground Ducts
Forms 8 Footings
_ _
�/
� �p
Ducts
Stab Grade
Return Air
Steel
/
Combustion Air
Roof Deck
/a/p %l
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
I
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
LY-/j'—Oy
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
3 - -� �O
Encapsulation
Gas Piping
10
Gas Test
Appliances
7-1
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)
06/22/2004 03:35 19497525321
June 14. 2004
GOUVIS ENGINEERING
Andy Fraser
Toll Brothers
73-121 Fred Waring Drive, Suite 100
.Palm Desert, CA 92260
Re: Muirfield at PGA West
GECG Job##60368
Phase 2
Lou 24 through 28
PAGE 01
Dear Mr. Fraser,
This letter advises that we have obser.�e' the structural requirements that are visible during construction
at the time of our site visit.
Gouvis Engineering believes that the as -built conste-Uttion 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
AN 7
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:
(;OUVIS ENGINEERING CONSULTING GROUP, INC CA
Christina Silva
Magdy Yacoub
V.P. Construction Administration
N
`� No. C 37201 w
EV. 6/30/06 ,{
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