9812-196 (SFD)LICENSED CONTRACTOR DECLARATION
C,)- 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
X04 Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
r-0LO
LLJ
'- ?32232 Iwo
oOZ Date?/�*" Signature of Contractor
rU C y OWNER -BUILDER DECLARATION
W UJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wage's 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
u')
N Date Signature of Owner
ON
rn
a Z WORKER'S COMPENSATION DECLARATION
C:) Er I hereby affirm under penalty of perjury one of the following declarations:
. H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W ILL compensation, as provided for by Section 3700 of the Labor Code, for the
O J QJ performance of the work for which this permit is issued.
C0 Q () ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Nt Z Carrier Policy No.
cb 0
�a �
J(This sect
_J nC3o- belcompleied if the permit valuation is f6r $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:
rovision .-
Date:"Fa
Applicant
Warnsecure Workers' Compensation coverage,,# 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
(�v�p & 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, andhereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. C
Signature (Owner/Agent) � / r " "6 � � Date"'
BUILDING PERMIT PERMIT# 06-
DATE VALUATION LOT 9812-196 R TRACT
I. 1 ?.4(0 $241.939.20 '21 28341-2
JOB SITE ` 'i
APN
ADDRESS
'S55-626 BRAE IBTJW
769-510-002
OWNER `~ —
CONTRACTOR / DESIGNER / ENGINEER
BIiOOKFIELD HOMES SAN DIEGO N. C.
BROOKFIELD HOMES SAN DIEGO INC.
12865 POINTE DFL MAR, SUM -,200
12865 POOME DEL MAR, SUITE 200
DEL 141AR CA 92014-3f
59 DEL ALAR Lid 92014-38:
(619)481-85001 CxBIA 5350
USE OF PERMIT
,I, », a.i L. Ly V,r,t r 1Nr
-9
LOT 2, .PLAN 2R, WD - :PERly T TOES NOT INCLLME BLOCK. WALLS O
1'OOL. P1,A AN G.HECr;..FL'k. RLMUCED 750% FOR 14RILT.1P.LE ISSUANCE OF
�n n
CUSTOM CONSTRUCTION 2,872,00113F
AORL"ATA'TIO 3".00 SF
GARAGE/CARPORT 677.00 SF
WSTJNWfED BOOT OF CONSTRUCTION
241,839.20
PERMIT FEE SUMMARY
C014S•TRUCV10N 'FEE 101-0000118-000 S11,136.50
PLAN CHECK fR 101-000-439-3.18 $210.42
MIX-fKANICAL FE1a 101-000-421-000 $85.50
E"L.P;6: TRICAL FhE 101-000-420--400 $171.56
PL1, NIBI1NG FEE 1.01-000-414-000 $179.23
STRONG A10 ION.1~r;E»RESID 1.01-004-241.000 $24.18
GRADi'NO PEE 101.000-4213-000 $20.00
NF_RAS'1'RVC1iTlt9,F 225.OW-443--2) $5,33146
ART IT "PUBLIC PLACCS - RUSIC 701-000-255-000 $354,60
SUB -1 VTAL CONS'1'KU{`"11ON AND PLAN CHECK
LESS PRE -P ID .RIES
Boal:
TOTAL PI RMff FEES DUB; NOW
S7,53"7
ffrr��
REM\i
� �
.DATE
BY
DA)E �VVCC 1dQLOE D
INSPECTOR
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
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. La h
S�
Final
FinalIC 4r
BLO KWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I 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
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)
COMMENTS:
"
Certificate of Occupancy
City of 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: 55-626 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-196
Occupancy Group: R-3 Type of Construction: VN Land Use Zone:. RL
Owner of Building: BROOKFIELD HOMES SAN DIEGO Address: 12865 POINTE DEL MAR STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR
Date: 1/30/01
Building Official
POST IN A CONSPICUOUS PLACE