0402-168 (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
777694 B f 4./30104
)ate ' /' c t Signature of Contractor
h ,
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.
(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``L2L = '/ Applicant \'Y. r. </ /L z, 'I
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employerto 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. h
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.
[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 forinspectionpurposes.
'Signature (Owner/Agent) ��' ! �yJ �' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT *D4ti2-1C,9 TRACT
- el r.' IP .d�i7.2CI 22 28838 4
JOB SITE
APN
ADDRESS
WAY
762-42"22
OWNER
CONTRACTOR /DESIGNER / EN (NEER
'OL .13 Z(2 ° WC
°�+'i71.i. �'� J'11 � NO
73-1211 d 10 WARDICT011110
73-131 FRED WARNG #100
1>Al2dLSEMIT CA 92260
PALU M3 RT CA, 9 260
(7€0)074®9699 (MAL41 3832
USE OF PERMIT
SW GLR' .YAVMY 1D�,`t31xL;C..Ir3(
.Sfkl - LOT 24 C&BRILd.. B. P'EtRAUT LDOV_� NOT INCLUDE BLOCK
WAL140, P004 SPA Ott D'kt-iV UWAY WIP ROACH
CUSTOM, CONSTRUCTION 4,162.011)5
rL,IAR
0 2 20Q4
PORCH/PATIO hI/PATIO) I,QStf.U9' sr
ORRAOVICARPORT W113.00 ,S`:11
" fa
3y OF LA ZUINTA
MAUTRD COST OF C0.1VS'rRUC ..011v
:aW,677.20
CONIVI RUCTION 1I ' E 101-000-418.000 $1,$23.50
PLAN CHWK FEE 101.000-439-318 $IX4.35
MEC:1iANIC'AL FI ZE 101-000-421.000 1260.00
ELEC T PLICAL FEE 101-000,420-000 $236.37
PL1.tMBINC, Y;E'' 101.000.419=000 5233,50
STRONO i1 OTION M - RESID 101.000.241-000 $35.37
0 i�40i+FE 101-000-4203-1000 $15.411
D.WFA,OPER INW.CT Imo'' V2,445.00
ABET IA PUBLIC K A,C ES - RF.S112'/11.000-445-000 $394.19
FEE DEPOSIT -$1,000.60
OONOTRUCROIT AAS PUNT' M
$6,373!28
U23 M-PAH)FE-ES
411000.00
TOTAL P=?Aff1° ."E8 VUE NOW
RECEIPT
DATE
BY 1/ /
DATE FFIINA D
INSPE TOR
INSPECTION RECORD
'OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 1._
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck p
Exhaust Fans
O.K. to Wrap 7D4L
F.A.U.
Framing z
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath d v Q
Drywall - Int. Lath
Final
Final
BLOCKWALL A PROVALS
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 Z7
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:
� -
S
6/
Apr 2S 04 02:53p RAYMOND FRANGIE 760 836 0856 p.1
R F STRUCTURAL CONSULTANTS, INC.
44-100 MONTEREY AVE. SUITE 201-C, PALM DESERT, CA. 922 J
PHONE (760) 836-1000 FAX (7601836-08N
N
E-MAIL R.FRANGIE@ E
APRIL 28, 2004
TOLL BROTHERS, INC.
81-380 LEGENDS WAY
LA QUINTA, CA. 92253
Attn.: MR. TODD SMITH
Re.: MUIRFIED VILLAGE, LOT # 222
PGA WEST, LEGEND WAY
` LEGENDS WAY
I LA QUINTA, CA.
FOLLOW-UP TO WALK THROUGH
t
JOB NO.: 413.4
DEAR TOD
THIS LETTER ADVISES THAT WE HAVE
UROBSERVED
G CONSTRUCTION AT THE TIME OF
REQUIREMENTS THAT ARE VISIBLE
OUR SITE VISIT.
WE BELIEVE THAT E WITH OUR STRUCON AT THE TIME OF TURAL PLANS AND ROUR
EV VISIT S
IN GENERAL CON ANT
'
CORRESPONDENCE ISSUED BY OUR OFFICE.
G
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:
FOOTING SIZE AND REINFORCEMENT, TOP PLATE SPLICES, ROOF SHEATHING,
AND ANY STRAPS ABOVE THE ROOF SHEATHING.).
RESPECTFULLY SUBMITTED
NICHOLAS F. ABOU-FADEL, PE
vt ErvciN�
5
"I'loc'Tov yo5o�oy
XO 90