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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
732232 13
Date g�? `5 Signature of Contractor /f7
' 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.
(J 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 section n n end no� belcomple ed 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: Applicant' \
`Warning: Failure to secure Workers' Compensation coverage is uta awful 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 riot 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.
qq r 4
Signature (Owner/Agent). jai ' •Z.� Date/,
v
BUILDING PERMIT PERMIT#
DATE VALUATION LOT .�-1 TRACT
->. -) -2 cl C/ $241,139.20 41 28341-2
JOOSIT �
APN
ADDRESS
-CSS 'BR E fiiitri
769-110-002
OWNER
CONTRACTOR/DESIGNER/ENGINEER
BROOKFIELD HONISS SAN DIEGO MIC.
BROOKFIELD HONAFS SAN DIEGO :;SIC.
12865 PO31v'1.'E DEL MAR, 8UTf1:� 200
128ti5 POINTE DEL MAR, Si;n`i'E 200
DE 1, MAIL CA. 92014-
.59 DEL NEAR Cts 92014-38a
(619)481-8:5{10 CBL#f 5350
USE OF PERMIT
k1INTt'll V VA k tXfpi if trTr.
LOT 4, PLAN 212. 81M - VERMiS'DORS NOT IIdCI:ODE, IaLOCK WALLS OR
POOL. PLAN CW CK FEEREDUCFJ3 750K FOR M R.TIPLE ISSUANCE, OF
4 + 'tom,
i,' kSTOM Wivt TRUCTI.ON 2872.00 S:w
POIcCUMATIO 364.00 Sr,
GARAWYCARPC)RT 677.00 *lig
ESTIMATED COST OF CONS"1'll llCCION
241,1139.21)
PERMIT FEE SUMMARY
CCi'NSTRITC'T(ON FEF 10140-418-000 51,136.50
PLAN CIEC% FEE 101-000-439-318 3^.M ;1-,
MhCHAN1CAL FEE 101-000-421-000 $85.50
L'I:.EC'RJR-A1. -'CW 101-000-420-000 X1';1156
PLUNI[BING FET. 101-000 419-000 $1-19.25
S`1' oNa ,Mario N ;1:7m . , tESID 10I -000-241-000 52,4. I$
clx XrJWG FEE 101-000-423-000 &20.00
1TRAS'k31i71:'I'lA2.E FEE 225-000.44.3-342 $5,332,46
ART IN PUBLIC PLACES � R.1~S'ID 701.000-:255-000 $3.54.60
SiJT340rEAL CQKS'1'RUUfI0N,&ND PLAN CIREC.K
$i',51�4.4 a
LESS PRL PA"!D'.P <E:S
$0.IV, 0
TOTAL I'ER3NIT FEES DUE, NOW
$7,534.47
/'k f
REEcP�TS� (. D/�TE
BY
D T�F ALEED
INSPECTOR
X\(I f- _,
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 Q
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D11- Int, L h
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)
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: 55-658 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-198
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BROOKFIELD HOMES SAN DIEGO
Building Official
Address:, 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 10/25/2000
POST IN A CONSPICUOUS*PLACE
The DanDee
tA*nWky dice. L is 732542
ROOFING AND CONSTRUCTION
BIDS TO:
BROOKFIELD HOMES
12865 POINTE DEL MAR, SUITE#200
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. Boa 277 Thousand Pal»ys, CA .9 276
Phone (760) 343-3385 Fax (760) 343-3096
JOB NAME;
HERITAGE COLLECTION
LA QUINTA, CA
BID# DATE 8122100
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 PIOMES ,
THE HERITAGE.
LOTS # 2001-2017 BRAE BURN t9 ` Z/ 6
LOTS # 3001-3019 BRAE BURN &,5� 161e,4E galtly
NOTICE
tinnpr the klp..chnNC$' tier, I..:]w (Goldurnia Cudc of Civil Piocedure. Section ;181 et Spq ) any cnntrpr..tor, subcontr9 tur, labur er. supplier other person he helps to
improve your property but is not pa!d rnr his work nr supplies, nos 1 ngfrt to cnfufcc a Bairn against your property. Thos means that. aftpr n rfii in he8nnq your urupully
could be solo by a rnun nriraf 111-1 Ihr,: pir_ux.;urls of the saM• used to satisfy the indebtedness This can happen even ;f you hirvt pjli!l your own corrtractof in full. If the
Sutx nnh:,rinr. 4dxx'rcr or suprlief remains unpaid and if legal action is nerassafy to rollprt oe FnfofCC thu terms of this contract, the prevailing parry shall be eniltred in cis
rcason3ole attorney fees plus all cnm i nil gptl an9 inipreSl Shall aCGuc illi ail sums. which are due 30 days after hftlmg at the rata. at 1R % Oe( annum The DanDee Co.
hic..s i+.ni rPgponsible fur dufays caused by weather, strike, material shortage ni delay in rnatelol Supplied to the job or to any other delay beyond its Control r he
no,oce Co Inc. total liability under this contract lir in negligence IC. hMitt+d suloiy to Ilio amount of this contract r
We are fully covered�y w4rkm2�'s �Qgtl]q.ation and public liability insurance. Carriers n�rtt����,ppJi�.y Dtirpbers a ailable on
request.
Any 1nPral110-1 lir tll,vialtor, quill the a abuve specification involving extra cost of material lir laonr will only lie eX0CuIL'd upon written orders for same, and will heromp
an extra charge over the sum mentioned in rhos proposal All Agreements must be nradC in wrilhing and is based on free access in building tnr ahem Inaaino Item our
vurKa
Prices are hawed on currpnt coals of material an(I labor. )nCreases or doCreases, will be reflected at time of signing contract.
Before lntf or during roofing operations and the completion of roofing, The DanDee Co Inc, will not he rpgpon$lbte or liable for CArnage cAuBo(l front
acts of God, such as earthquakes, thuneerstorrts, hall or Any other weather conditions beyond rooters control.
I)A'I F
DATF•.
I'l II? DANDEL C'U.
I112OPOSAI, VAI.II) FOR DAYS
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