0402-156 (SFD)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 / B 4130/04
Date Signature of Contractor l
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.
F:113FRTY MUTUAL F; W.A26217t W11.3012Ti
(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. _
, , j .f.<,
Signature (Owner/Agent) Date
its;
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0402-103 TRACT
5.1
24
JOB SITE
APN
ADDRESS
81.-370 GOIX, AIEW taRrVE
762-41C3-024
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T01: L IM01HERS 19C
TOT1, 6720Th ME1 D C
73-127
7:1-1213 W�MdN_ 0100
PALM DEb .T CA 92260
PALM Y31 SWf CA 92260
(760>674.9699 L" TJi 3832
USE OF PERMIT
SM - LC:1`t 74, U&NTA ROS.A-B/41pal i.o. PERMIT DOES'rlOT INCLUDE
BID WA►,1_:9,, Pool, SPA OR CDRIIVEWAY•APPRO.ACH
b
ktT;3' Ohtl C:OMS'f'l UCT1011 V41,00 OF
PURC'1 /PATIO 444.00 a1+' IUI MAR
0 2 2004
0A1tA.0 VICIAR1°C.W? 756.00 OF
CITY Cr['
FIN
LA0—U!Iit—TA
".CE DEPT.-
1y,,�(�, �,�qo�gg,qQ ,,���ye.�ppyy.����,yy /��r� '9, �/�!,�l q;�r'�V,'�7rq'�('y ( ♦gyp
.GAiwJf.dA4d.L33�lae+ co.&'.4 of c.o., .i7,l..d6V4.,ril�/.lY
{yq y ��' y�
312J46.70
aJ,lnL9d.' 6. 0
C014*1`'1'RUC T I ON FEB 101=90X1-47 9.000 $1,383.00
PLAN C'HWK, FEE'' . - 101-000.439-318 'x1,117. tv
M:C ANFCAL FE 101-000-421-00'- $1,19.00
CLECTPJCAL FEE: 101-000-420 060 V03.06
P1piJMOTPHO FEE 101-000-.419-000 S1 ¢0.00
TrRONO MOTION FEES - RF -SID 101-000-241-000 $31.21
C .0,10 FEE 101-000-423-000 115100
DEVELA)P,ER IMPACT PPE $2,405.00
ARX 1N P0131:SC PLACES - RES1L 270-000445.000
9UB-TOTAL COI93'r_FZXJC°t.f0W' PLW CM -Exec.
$5,744.:
1., S PRE -P IMM
$C%07
TOTAL PE'Rii/ATX . E,S DUE NOW
S-5e7'44A 3
RECEIPT
DATE
BY ,
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs_
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
_
Exhaust Fans
O.K. to Wrap
9f
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
BLOCKWALL APPROVALS
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—/ --
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
06/22/2004 03:35 19497525321 GOWIS ENGINEERING PAGE 01
0
t:STi'jS(.1ff:i1'f.'.� �I"tT1r�%, FFIr,.
June 14. 2004
Andy Fraser
Toll Brothers
73-121 Fred Waring Drive, Suite 100
Palm Desert, CA 92260
Re: Muirfm4d at PGA West
GECG )ob4*60368
Phase 2
Lou 24 through 28
Dear Mr. Fraser.
This letter advises that we have obsery d the structural requirements that are visible during construction
at the time of our site visit. "
Gouvis Engineering believes that the as -built construction 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 be an 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 ocher trades or
requirements of subject dwelling.
Respectfully Submitted:
GOUVIS ENGINEERING CONSULTING GROUP, INC.
Christina Silva Magdy Yacoub
V.P. Construction Administration
919.7.'7..1(c1?.
has v49.7. 51 1
.. Nct4vpc+i 1 Kr:n:h, CA
��'1Sg1NAR.SG
No. C 37201 .
_ 22! 2001.6/
I':,hil Sp iiigu, CA C:i Sacrailtcntr),.(.A S:tll l.,tlk,. Cit" (rI, I[,, (.:Ili :�lialt l it+. \ iiln:ut