9812-199 (SFD)U) .
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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
7322-32
.,Date `7 Z / Signature of Contractor` V
.f1 r�
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.
V) 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 IPolicy No.
(This section ne d o�t belcomplefed if the permit valuation Is;for $160.00 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. f
Date:" Applicant ! o
Warning: Failure to secure Workers' Compensation coverage is u lawful 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.
(,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.
f < "7
/Signature (Owner/Agent)A .�! r`- �L!•r Date Zi i''
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
• 11 $262,64.1.90 5 28:1.11-2
JOB SITE
APN
ADDRESS
5S4`74 8RAF, BURN
769-510-0.2•
OWNER CONTRACTOR/DESIGNER/ENGINEER
BROOKP.ELD HOMES SAN DIEGO INC. B1'.f.3LDKVIELD HOMES SAN DIEGO INC,
12865 POIAi I'E DEL MAR, SifffE 200 128615 POINTE DEI KLA.R, SUrl-E 200
DEL rVLA.R CA !r,.014-3"59 ,DEL MAR CA 92014-38:
(619)481-8500 CBL# 5350
USE OF PERMIT
LOT 5, PLAN 31_ SF'D - PEMT DOES NOT INCLUDE BLOCK WALLS OR
'POOL, PLAN CHECK FEE REDUCEM 75% FOR NfM TIPLE ISSUANC73 O
CIA A4117 At TV
CUSTOM t"'O MSI Tlit.lUC7'TON 3,140.00 XF
PORC"ATIO 5.14.00 Sr.
Cr.ARAOF)CARPORT 727.00 SF
ESTIMATE .ST C3Ii+ C'.(iNS:M`RdYC IaN
262,641A
PERMTIWE SUMIWARY
CONSTRUCTION rEF 101 -00041f3 -{?00 SLV0.00
318� $245f.n37t
PLAN CHECK FEF 101-000439-�
l/
tl�l.i C ie'.�t�I.CAL I'FE 101`00042 1.-WO59100
I LEC"'tfUCAL FEE 101-000420-000 SIW54
PLUMBING FSE, 101-000-419-000 $192.75
STRONG MOTION FEE, - RES1D t01-000-241-000 $26.2b
0RAD INC) FEE 101-000-423-000 $20,00
INFRASTRUC".1`lJRE FEE ^1.25-000-413-342 $5,754.13
ART i'N.PUBLIC". PLACES -1t "STC 701-000-255-000 _406,60
Si.WCilli" r. rON R r IC 110N : 14'i) FLRsl CHECK
$AM21.65
.ESS Pkv; -PAID VEXS
$10.00
TOTAL PERMIT FEES DUE NMV
58,127.65
E _T!}Y,
DATE
BY
DATE NALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 41
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap 9f
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
D II - Int. Lath
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
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 4alul 474
Utility Notice (Perm)
COMMENTS:
Certificate of Occupancy
City of La Qdinta
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: 55-674 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-199
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
Building Official
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 10/25/2000
POST IN A CONSPICUOUS PLACE
The DanDee
(AImkyr hoc•. Lie 732542
ROOF/NG 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 277 Thousand Pa/ms, CA .91176
Phone (760) 343-3385 Fax (760) 343-3096
JOB NAME:
HERITAGE COLLECTION
LA QUINTA, CA
BID# DATE 8122100
THE OANDEE CO. INC_ HAS INSTALLED THE ROOF DORMER VENTS CORRECTLY, AND AS PER
ENGINEERS SPECIFICATIONS ANO OR DRAWINGS AT THE JOB SITE KNOWN AS BROOKFIELD HOMES,
THE HERITAGE.
LOTS # 2001-2017 BRAE BURN zoo T
LOTS # 3001-3019 BRAE BURN 1'57 15 0 7� 8 Oeolil Z4�e/
NOTICE
'Under the ro"zin cs t ieri f.:1w (C:lhrurniu CiUdu,of Civll Procedure. Section! 181 ei Req ) any contractor, stihContlaCtur, labur or, supplier other person he helps to
improve your property but is not prig for his work Lir supplies., nos a nghl to enfurc a claim against your property. Trays means that. Aller n n(uift Fleannp your wuputy
could be sold by A enun ntynei frn.1 lhf.a puN:CClIs pf thu s0i, used to satisfy the indebtedness This Call happen even if you I1ttve pool ymn own cun4ilCtur In full. It the
, b(.nntlAC,tn). Ipbglul Ui supplier remains unpaid and if legal action is necP.SPAry to nollenf or r llfrifoc thu terms of this contract, the prevailing party snail be entitled In IIA
icasonaole attorney fees p1119 all cn4IB 01,41111 Anrl IntPfP.St Shall aCUuc an all sums. which are due 30 days after hitting At lhP rate. at 1R `yo pE( 81111um The DanDee Co.
Inc. is Lint rPalxln$ible fur dolays caused by weather, strike, material shortage Lir delay in material supplied to the job outer
or to any delay beyond its Control I he
f1zn:Dce Co inc. total liability under this contract Lir in negligence it IimibAf Wkly to the amount of this Contract
We are fully coveved�y_w4rkmt�n'S r_,_QMpvj voti9n and public liability insurance. Carr Qr� n�m���� pp�it.y northers available on
request
Any ,ills;)Iroi or cl(-yi;,llitir, 4om !Ile a LiWve specifications involving extra cost of material or lannr will only be exCCut('d upun wrilten oideis for same, and will hernme
an extra charge over the sum mentioned In thrA proposal All agreements most be diode in wtilhing and is based on free access to nuurling for direct Inaoino vom our
I; uf.RA
Arice9 are baited on current cost9 of material An(1 IAhor. 1110108808 or docreases, will be reflected at time of signing contract.
Before 0110 or during roofing operations and the completion of roofing, The DanDee Cc Inc, will not be regponslnte or llagle for dAmade causod from
acts of God, such as earthquakes, Ihunaeratorills, hAII or Any Oilror weather conditions beyond roofers control.
0A' I F.
f)ATF
H IF DA111>1iL•' C'U.
IIR( PO') A1, VALID FOR DAYS
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