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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
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Datel5;3 Signature of Contractor
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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 isnot 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.
I i 7S CO
O " 'i it S i All iCa"VVX11_'. ,'r4"-0 `2^1,61
(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 sFf'all forthwith comply with those provisions.
Applicants
Warnmg. Failure to secure Workers Compensation coveragg/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, 8 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 inspectionpurposes.
Signature (Owner/Agent) -% %�'- Date
! ! 5/L9
Y,� fir.• v. —
PERMIT #
BUILDING PERMIT 7
9812,410
DATE _ VALUATION .Sd3'�.2(t LOT 31 TRACT N341 2
JOB SITEc7�•
ADDRESS 5:x 647 Bjme .i3U1�,t'�t
APN
749-510-0,14
OWNER
/ DESIGNER / ENGIN EERimc
4 {CONTRACTOR
p� d041%4,fil"S'Y },IAi.lkq �F�`'.��,J All
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11 t��Ixkl\.�I�IJ414.r iV tl.R',1, ,AA1A1 All la 1{�i l..
i'2863 MKM EL MAR, SUrf;v 200
i 2.865 k'L3f MI, Dill, MAR, SiAT. E 200
DEL MAR CA 912014-3M
U1 i, MAR CA 12014--18v
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USE OF PERMIT
Lo—, :. f LAN 2R. 3x'13 - C°ZU[T DOVS NOT INCLUDE IRLCr k WALLS
0=10M CONSTRUC:T10114 4,8 72.00 Say
C'i Al2r�J 3f,'tt1�.li'C' �"; 7.t)(i S,P •
PERNUT FEE SIM WARV
C0NS'fR.[. CfION liFE' 101 -000-418-000
PIAN CHECK VFP 101-4100-437-318 �:94f.Fss
c+17 C13r Nxc:rit, OUT" 101-000-121.040
c:i.IXIIUCAL FLL- 101-0W_,.FJ20-000 s►11,5fi
PLUMBINU FEET 101-000-41.9-000 $ i lN,75
,',7 .)r40 MOTION, FEF RFS[t? 1.0E -W-241.000 $2A 18
GRADING FIZE 1.01-000411-000 520.00
N1ILkST12ii1;TMEREE 225-000-443-3421 S5,3R.46
A1k1' f'N PUBLIC PLACES - RESIt 701-,000-255-M fi35i.4if1
SK61;1-'674}'1 A CO'NgrI U(, 0' ' AN9A.A C FIC;
LESS 1'1t<'ETAID FEES
$0.00
'��O�€ AL REAM%*r FEIRS .+ I. �' OW
88,225.73
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IN AQ IN AI ' 111
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DATEBY
DgTE,,F LED
INSPECTOR
a'k'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
1A 4 A
Ducts
Slab Grade
Return Air
Steel
T.4
Combustion Air
Roof Deck
,$
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
Final
Final
BLOCKWALL APPROV LS
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
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) 710'-7177 jV,1
COMMENTS:
Certificatelof 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: 55-647 BREA BURN
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-187
R3 Type of Construction: VN
Owner of Building: BROOKFIELD HOMES SAN DIEGO
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Building Official
Land Use Zone: RL
Address: - 12865 POINTE DEL MAR, SUITE 200
City: DEL MAR, CA., 92014-3859
By: Daniel P. Crawford Jr.
Date: 10-20-99
POST IN A CONSPICUOUS PLACE