9812-186 (SFD)LICENSED CONTRACTOR DECLARATION
•�� *' I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in full force and effect.
O =) M License # �Lyic. Class Exp. Date
r— Date `� "1.2 `� 't Signature Of Contractor / // (� />>-
Z
coOO `1. /, / ' l,�`,;r �{t x.: t✓
J U (D OWNER -BUILDER DECLARATION
W LU I hereby affirm under penally 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 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).
C'`) () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
CD
Q WORKER'S COMPENSATION DECLARATION
CL
C:) < fr I hereby affirm under penalty of perjury one of the following declarations:
r O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
to _ Q performance of the work for which this permit is issued.
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
rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
..:I- Z Carrier Policy No.
CO 5 1,q�i e r, t.+•o� •� q9 r1 rte'! ^t rhr
0 :It"m co�iiJ ��1. TY`I�: lA S i�.X 13IN .vC ,1'�i f •�J'
J (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. 1
Date:' �— .- �. Applicant ' � Ions,
, i
Warniail
ng: 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 inspections purposes. .
Signature (Owner/Agent) 7 � / . Date
Pira t v✓cy � f � ..
PERMIT #
BUILDING PERMIT11'
DATE VALUATION LOT TRACT 8341-2
•'7
JOB SITE7 ��.����2yy
ADDRESS RN\
APN
6) 510 -0 14
OWNER
CONTRACTOR / DESIGNER / ENGINEER
f3.R.00KAII1F,.')11404 E11114,PIN 91FC-011`IC.
t11)010,'.�;'IF,i.DI10NIF.'.SSAr:r,0101NIC.
121363PCJINI t DEL hIAR. SUTM 200
i lSu i rPOiiv E'' i3Et:.I<'I'.t R, SUFM 200
IXEL,MAR CA 92014-{859
013L MAK CA 92014-39!
USE OF PERMIT
S1.NCILE Ftl:niILY f WEIL.NG
0R.-
LOT 2, 1}LAN 3, Sri) - i'C-MiiT riS N%.I `,I'NC .U'DF MOCK WALLS 0R.-
+•K1N
is,��Cv11Sn
',403F
PORi 'X 02100 &F
0ARA4UMARVORT 713,OU Sr
PERMIT Via, *SUM-OkUR #
C'( tOffRUC JON Ms" 101-00 0-418-000 S1,077M
1'1.Af'4 f ;d'k }Ti !0100-439-318 ! 877 29
Ilt1;st"3 +fdlC;es1,r2rX 101.000.421-000 $179.0
ELLC1WCAL ITS, 101 -W -420-01W $164.0
PJARVISING FFF 101 -OW -4t9 -WO 3185.25
STR0NO. }y(.1^a,1(74,4 t»"f l; R{ SK) 111(4V1-241-(YW) X12 48
011ADING FIX 1.01.-1100.423.000 51.10.00
;1NOWi1'.fZi:C"1UW3RU 14151-(lUA•443-342, 54,967.98
.!#11 f IN ,! 031,1C PLACES -.RESlt 101-000-255-000 $312,04
r
SUB -TOTAL CONS'T((IJC,71,ON'ANiDPI-ANCliECK
$7.705,73
LM =-PALCI FES
$0,00
V
�FEIIP
BY i
DqT� NALE
INSPECTOR
� � v
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs Underground
Ducts
Forms & Footings 1AA Ducts
Slab Grade Return
Air
Steel Combustion
Air
Roof Deck S Exhaust
Fans
OX 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. Latlj
Q
Final
Final
BLOCKWALL APPROVALS steel
POOLS - SPAS
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
Electric
Test
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:
Ab
Certificate of Occup'ancy'
City of La Quinta
Building and Safety Department OF,�E°`'4
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: 55-631 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of�Construction:
Owner of Building: BROOKFIELD HOMES SAN DIEGO
Building Official
vni
Bldg. Permit No.: 9812-186
Land Use Zone: RL
Address: 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 10-27-99
POST IN A CONSPICUOUS PLACE