0306-070 (SFD)LICENSED CONTRACTOR DECLARATION
khereby 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
2177,699 B
Date �� ''��� Signature of Contractor
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.
() 1 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 LIBERTY' MPUT QQr 7 Policy No. =41271
(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.
I Signature (Owner/Agent)
�r
t
Date
PERMIT #
BUILDING PERMIT
DATE VALUATION' LOT TRACT
JOB SITE r�'L44'4�sfi�its1� : /
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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uf).h6,�i WT�1fC(7Y f 100
P.i'LMli.i:'EFAT V1. W260
I?4MC.3.['A�F'e'.!.\.i. CA MW
USE OF PERMIT
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RUX.r WALL,% I''aaE;St.�, tfi'PIA Dk'iWN`�.H.YAPPROt.,,I.CH
(;)1g3; (��aq tW �ti:Tlf i3iPTi "rA� =#,3 i",i5 SP
730,0 SF
J,&:%.:;i":IdSuYl C09X OF C PiS+l..RITG✓.►,.711'.l!
�;G' b KE &M'i, :tUn"
MJ'A"113TRUMON, )VIBTZ 103 -000.41 �-'-000 $131 6m
�I�G�•7LPC.-Y>'.f''e`�c '. �6at:-(�.f)S)-/�3�-sl% �E,a6x.x0
.MECHANUCAL FVC 3 01-d00.4Z 1-M' M56.50
:;;..0
#si-t?�JiEiTk��S d 1 01-('�;�-4
WN01140T)C a 7FIR .• ;a :110 2+31-000- 1 � _ODO
,0RAVINQ FRE, 101.000.423.0063 I i 3M
.
I' RT XX PUBidC ?•L4 - -UR aRf ^Q �aa•�ucsis � i ;fa•' o
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P 40 7}fJ�
P, 4`1
JUN 1g 2003 ..
CITY OF LA QUINTA
FINANCE DEPT
RECEIPT
DATE _,�.,�
,BY ' /
DATE FIN ED i
INSPECJO�
t�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footingsgx
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K.to Wrap
F.A.U.
Framing
I A.4
Compressor
Insulatio
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath IN
Drywall - Int. Lath
Final
Final iY a s
BLOCKWALL APPROVALS
POOLS - 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
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 A)
Gas Piping
Gas Test
Appliances -
'•
Final
Final z
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) I Z-1 (Z or
COMMENTS:
CALIFORNIA
GO UVIS ENGINEERING
C A L I F O R. N I A
E—MAIL TO • SUPPORT@GOUVISGROUP.COM • SALES@GOUVISGROUP.COM
•
September 2, 2003
Todd Smith
Toll Brothers
73-121 Fred Waring Drive — Ste. 100
Palm Desert, CA 92260
Re: Muirfield at PGA West
Lot 23
G.E.C.G.60368
Dear Mr. Smith,
•
i
1 2003
This letter advises that we have observed 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 (except items
noted on field notes) 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, roof and top plate splice connections 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 other trades or requirements of subject dwelling.
Respectfully Submi"
Gouvi ngine Consulting Group
Saee Bekam 7j�fi,�s0 J 81
t
Presiden,';,.,t=',� V,
SJB:SV:cb
090203a
t
t
b
No. C38276
. 3/31/05
Ea (i � X03
'+wC I V 1 �/
onny Vinoya
roject Manager
GOUVIS ENGINEERING GROUP OF COMPANIES WITH OFFICES IN: WEB—SITE: H7TP11WivW.000V1SGR0UP. C0M
4400 CAMPUS DRIVE, SUITE A . NEWPORT BEACH, CALIFORNIA 92660 • (949) 752-1612 . FAX (949) 752-5321
2150 EAST TAHQUITZ CANYON, SUITE 9' • PALM SPRINGS, CALIFORNIA 92262 (760) 323-5090 • FAX (760) 325-2863
FIELD OFFICE: NORTHERN CALIFORNIA — INTERNATIONAL OFFICE: VIETNAM