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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
'r3 l3�l3D
Date - 52ignature 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.
Q) 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 sectioonSnee not be i;6Q41ed if the permit valuation is fbr T00.00 bNess).
(. ) 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:."'/, �r1 Applicant—f'f� %
Warning: Failure to secure Workers' Compensation coveraciis 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.
0 f %
—Signature (Owner/Agent) �f I ✓ -� Date 3/
BUILDING PERMIT PERMIT#
e�/�FiE�EIP
DATE VALUATION LOT 9'JI�2»j�l?' TRACT
- Z•-j�� 5262,61:190 28,741-2
JOB SITE
APN
ADDRESS - -
_"2, BRAE H URNI
769-510-t1i12
OWNER CONTRACTOR/DESIGNER/ENGINEER
BROOKFIELD HOMES SAN DIEGO INC. BROOKFIELD HOMES SAN DIEGO INC.
12865 PO.IMft' DPL N A.tt, SUi"M 2110 12865 POINTE DEL Mf1R,. SL T.. 200
DEL MAR CA, !r2014 -X59 . DEL Wk R CA. 92014.38:
(619)481.8500 CBL# 5350
USE OF PERMIT
00, 11bY
3; PLAN 3R. SFD - P;ERNUT'DOES NOT INCLUDE BL(XK WALLS OR.
.LOT
POOL. PLAN CIOICK FEE REDUCED 7Wo FOR )VlXILTMIX ISSUANCE OF
s
CUSTOM CONSTRUC:FI N :3,100.00 SF
PORMPATIO SH 00 8F
0A.RIAC*&CAk2PORT 7V-00 .SF
OTtIlSX! ED COST OF CONS'1i RB1UION
26-,641.,94)
PERMIT YEE SUNViMIARY
CONSTRUCTIONFEE .101-000-418-000 $421.0.00
PLAN CkffiCK F'EE 10.1-000-439-318 $245.37
1kIFSCHANICAL FEE 10:-(IOOtI421-000 3912 00
19LEC 11tICAL FEE 101-000-420-000 3180.54
PLUNIHING FEE 101-000-40-000 $192.75
STiarYNG'Mal'1014 FEE - ][ ES1D 101-000-241-000 326.26
61RAD:ING "F 1i'E 10.1-000-423-UCIt,} $20,N)
INF1RAS'.VRUCI'URC IEEE 225-0004 43-.312 S3,759-4.1.3
ART IN PU ILIC PLACES - lRESW, 70.14000-755-000 S-106.60
SUWMT.AL C O; SM(L+GRON ,AND PLA CHECK
SU T ; ,b5
LESS PRE -PAID FEES
$41.01)
7'OT:f1L PERA11T PEES DUEI`TOW
X�
$8,1.27.65
Al A A 4.
',
n
DATE
BY ;'�t'
DgTE INAL
/I
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs j.A
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. Lath
17
Final
Final--
BLOCKWALL 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
;X Ida
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:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group:
55-642 BRAE BURN
R-3 Type of Construction:
VN
Bldg. Permit No.: 9812-197
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: 11/15/2000
Building Official
POST IN A CONSPICUOUS PLACE
q41' & t' " /� �
The DanDee
CAmmWiLy h'c•. t is 732542
ROOFING AND CONSTRUCTION
BIDS TO:
BROOKFIELD HOMES
12865 POINTE DEL MAR, SUITE4200
DEL MAR, CA 92014
PHONE# 858-481-8500 FAX# 564-8317
TO WHOM IT MAY CONCERN.
RE; O-HAGIN ROOF DORMER VENTS
Roofing Proposal
P.O. Box 177 Thousand Pains, CA .91176
Phone (760) 343-3385 Fax (760) 343-3096
JOB NAME:
HERITAGE COLLECTION
LA QUINTA, CA
BID# DATE 8122/00
t orT 3E'
.5'S'6 Z,/,, BRAE 8a elt/
THE DANDEE CO. INC. HAS INSTALLED THE ROOF DORMER VENTS CORRECTLY, AND AS PER
ENGINEERS SPECIFICATIONS AND OR DRAWINGS AT THE JOB SITE KNOWN AS BROOKFIELD HOMES,
THE HERITAGE.
LOTS # 2001-2017 BRAE BURN
LOTS # 3001-3019 BRAE BURN
NOTICE
A)ndP.r the hIpchAnir;S' I ;rr. Law (Calrrurnw Cude of Civil Proceduie. Section t 181 et Seri ) Any cnntrartor, Std)Conbaiaur, laborer. supplier other person he helps to
improve gout property but Is not paid for h1% work or minpite.R. his p oath to Clt(urtx u daim against your property. This meAnB that, atter a nt ,% fit hP.nrntft ytiln jiupully
roulo he som by a court nfRrei port wft pupl;cels of the s21lr; used to satisfy the indebtedness Tills can happen r:vrn it you hi -c pokil your own comiactar in full. If the
:;uhrnnharinr. 41bt3rcr yr suppliel remains unpaid and If legal action is ner.Aasary to noitect or enrofCc tbu tarns of this contract, the prevailing pany shaft he entrned to da
rcason3ole attorney fees plu% all (MSIR of Still Ann interest $hall XCtuc all all suins. which are due 30 days after hitling At the mite at 1A % Oe( 04111LVn The DanDee Co.
hu:. rs lint responsible tui delays caused by weather, strike, material shonage lir dr ray to mite+!'+l suptilted to the job or to any other delay beyona ns control I he
DanDee Co Inc. total liability uniter this contract lir in nfigligenre it. hrnitutf sululy to rho amount of this contract
We are fully covergd__�y.w4rkmen s yQiltnis�kion and public liabiljty insurance. Carr iernAMg.�-prg go)iC.Y otimhers available on
request.
Any pneraiion or oeviailon floor tilt` a above specific:atiuts involving extra cost of mAtp.rial or labnr will only be exCCuted upon wtilten orders for same, and will hecoma
an exua charge over rhe sum menhonea In rhts proposal All agreements must be made in wl Ithing and is based on free access to budding for duert Inapnhp ri oro (1111
IfI,CAR
Prices are haled on current colla of material an(l IBhor. 11IM88e8 or decreases, will be reflected at time of signing contract.
Before 0110 or during roofing operations and the completion of roofing, The DanDee Co Inc, will not he regponelt)le or nBi)ie for dAmage causotl from
acts of God, such as earthquakes, thunderstorms, hall or Ally otbor wuather conditions beyond motets control.
f)A I l-:
F)ATF.
1111{ DANDU C'U.
f)ROPOSAI. VAI.(I) VOR DAYS
ZO'd 31IHM W01 dOZ=iO 00—ZZ-61-11i/