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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
�3! $2 128/
1y2� F /
,Date �/, Signature of Contractor�� %,� -t��
r OWNER -BUILDER DECLARATION
1 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 Siqnature 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.
(a) 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 thi's
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This sectIo need nOoFbe complefed if the permit valuation I`sor$1'00 00 0oless).
( ) 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 provision ^(
Date: ? -z /r'� Applicant `.1 � � �
Warning: Failure to secure Workers' Compensation coverag 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 propertyforinsppe�ctio. purposes..
Signature (Owner/Agent) 116 0- L(- Date� 3
A
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9812-19STRACT
JOB SITE -
ADDRESS
[APN
4 r. AjF`. .. 1$2'fel. .
-76k9_151 Oi
OWNER CONTRACTOR / DESIGNER / ENGINEER
BROO[+;FIE DHOWS SAN DIEGO INC, BROt .UtELD HOMES SAN' DIEGO INC.
123651aONTE DEL N1,AR, SUME 200 12865 lat;9DWE DEL MAR, SUTr E �00
DEL. rvLkR CA 920143 59. • DEL MAR CA 92014-38_
CBL#
USE OF PERMIT
W17 1, PLAN .IR..3FD - PFANOT DOES NO t T_N0..UDE 131.(X`K. [RrAL.1.S OR
P001- P'1,.AN CHECKFU, RF.DUM, ) 731-, .FOR MULTIPLE ISSUANCE OF
r r nr gree
CLf3T0N1 CONS'tRUC'11ON '214555.00 SF
PORCH/PATIO 30100 SI'
t'lAP.A0+1CARP0RT 7.1100 SF
USTINIAT i:1) COST OF CONSTRUCTION
22-,315.90
p.ERNUT FEE 5tC MNIA'RY
CONSTRUCTION FEIF 101-000.418-{ifi() 51,077.00
?LAN CdiP.C.`i4FEE 100-000-439-318 $219:32
A HCHAMCAL.FF'E 1.01-000-421-000 S,70)0
ELECTRICAL .FM 101-000420-000 $164,19
PLUMBING FEE 101 -000 -419 -ON 5185.2 i
,TFRONtI M(YrION FEE -PXSW 101-000-2.41-0003 $22..48
GRA1a NG FEE 1.01-000.423-0043 $:20,00
1•WRASTRU("'1Uft. 'FEE 22.5-000-443-342 94,967.93
ART '1'N P1_T8UC..` PLACES E3113 001.000-255-000 $3.1111
SUS -TOTAL Ct'3NS"i U C'I100 OD PLAN CHECK
$7,047.715
LESS PRE -PAW f;E'ES
$0.00
TOTS-L..PETd.31'I. T FEES [1.01Ei11OW
$7,047.76
• �1
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PIN , .
tREC,, i �• � Ni
DATE
BY / ,
DrE INA_ LED
INSPECTOR
,! .N1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck S414Exhaust
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 /
Dryyjall - Int. Lat
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
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)
Certificate o.f Occupancy
City o.f La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in 'compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
55-610 BRAE BURN
R-3 Type of Construction: VN
Owner of Building: BR_OOLKFIELD HOMES SAN DIEGO
Building Official
Bldg. Permit No.:
Land Use Zone:
9812-195
RL
Address: 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 11 /22/99
POST IN A CONSPICUOUS PLACE