9812-200 (SFD)LICENSED CONTRACTOR DECLARATION
1 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
04 W Professionals Code, and my License is in full force and effect.
O =) M `License # Lic. Class Exp. Date
t --C Y U.)
Lu
"r3"2232 1sljJCj
ZO r— ate �� '"%" Signature of Contractor4' �
J U C:) OWNER -BUILDER DECLARATION
HUJ r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
UY 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).
t'') () I am exempt under Section B&P.C. for this reason
ul
N Date Signature of Owner
ON
rn
a Q WORKER'S COMPENSATION DECLARATION
oI hereby affirm under penalty of perjury one of the following declarations:
n O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
Oro � Q performance of the work for which this permit is issued.
Q C) (x) I have and will maintain workers' compensation insurance, as required by
OLO Q Section 3700 of the Labor Code, for the performance of the work for which this
d 0)H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Canier Policy No.
co. =
0 MIS CO OF THE STAT PO4OW-C 347'-05%
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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. µ'
Date: Applicant %.% /1—�- �•--
Warning: Failure to secure Wor ers' Compensation coverage is , nlawful 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.
Signature (Owner/Agent)/ Date 7
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9812.200 TRACT of
Z3 .��� $224,815.90 6 28.1-.11- ,
JOB SITE
APN
Yy
56,40ADDRESS �0 BRAE UURN `
769-5510-002
OWNER
CONTRACTOR/DESIGNER/ENGINEER
BROOKFIELD MONIES SAN DIEGO INC.
BROOKFIELD HOMES S.AN DIEGO INC.
1.286-5 P0111 IT. DEL MAR, SUITS 200
12865 POITNUE DEL &1AR,, I+Ur1E YK)
0 E L MAR CA 92014-31,
59," DEL MAR CA 921014-38,
(619)431-000 c,..W 5350
USE OF PERMIT
LOT 6, PLAN 1R. SrG - PER.MfT D(DES NOT INCLUDE BLOCK WALLS OR
POOL. PLAN CHECK FEE REDUCED 75% ,F'Olt NfULTIPL'E; 1SSUANCTT OF
SAME PLAN TYPE.
CUSTOM C0148TRUCTION 2,655,00 SF
POR Erdl'r!'i IO . ' 302.06 Sr
GAP.ACr_/CA[LPoR•r 713,00 SF
EST.1N1A'TLJ D COST Or! CO NS T AWF IGN
224,815.90
PER -NUT FEE SUMMARY
ONITCRi:rGC ON FEE 101.000-418-000 $1,077.00
PLA14 CFWX.K FEE 101.000-439-31.8 $219.32
MFC'NANICAL FEE 101-000-421-000 S79.v'U
FILE.C11RICr1.I.I PLE 101.-01}0-420-000 x,16169
PLCJN4B11 0 FEE 101-000-439-000 $185,25
STRONG MOTION FEE'-11ES:1.0 10,1-000-241-000 $22.48
GRADING FU- ' 101-00042.3400 $20,00
INFRASTRUC110LE FEV X25-000-44.1-342 1,9ts7.9g
ART .IN PUBLICPLACES • RESM 10.1.-000.255-000 $31 iii
SLTWT0'hL CONSXRt3MON AND PLAN CIM CK
�7,ltAt'�.7ti
LESS PRC IT ZS
Sl) .)(1
TOTAL PERMIT FEES DUE NOW
S7,047.76
l 1
RECEIPT/
5�e �/ 11�.
DATE
BY i+}�
V�
DA INAL
INSPECTOR
V,.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms S Footings
Ducts
Slab Grade
Retum Air
Steel 74
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 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
Utility Notice (Perm),71 T1
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: 55-690 BRAE BURN
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING Bldg. Permit No.: 9812-200
R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BROOKFIELD HOMES
Tom-► A-1,
Building Official _
Address: 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 9/13/2000
POST IN A CONSPICUOUS PLACE
The DanDee
cm, ky Me. L is 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 Patiins, CA .92276
Phone (760) 343-3305 Fax (760) 343-3096
JOB NAME:
HERITAGE COLLECTION
LA QUINTA, CA
BID# DATE 8/22100
THE DANDEE CO. INC. HAS INSTALLED THE ROOF DORMER VENTS CORRECTLY, AND A5 PER
ENGINEERS SPECIFICATIONS AND OR DRAWINGS AT THE JOB SITE KNOWN AS BROOKFIELD HOMES,
THE HERITAGE.
LOTS # 2001-2017 BRAE BURN /, 6 E
LOTS # 3001-3019 BRAE BURN
NOTI C E
iinoP.r lhP roptch9nics, t ;er, l.aW (CJhrurma Cud of Civil Procedure. Section! 181 ei Seq ) any cnntrartftr, strllcontr, jCtur, laborer. supplier other person he helps to
improve your property but is not pain tar hIS work Of BuppIIP.S, 11M I t0it IV cafufw a claim against your property. Tris means that. after a rriurl heannrl your orupurly
could ne Sold by 9 QCurt ofrir.Pr Ind Ihre prcx;ccds of Oto Salk used to satisfy the indebtedness This can happen eveti ;f yo,., have {k ir,! yotn own conaactur in full. If the
tirnc�nntrartar. 1;tl�rper ur supplier remains unpaid and if legal action is nPnesSary to coilert ve hrtfofcc (tic tarns of this contract, the prevailing party shall FF P.ntitlert In [I9
rcason3ole attorney fees. plus all rn91s tit slut ane intPfe,St Shall aWtic an all sums. which are due 30 days alter hillmg al the rate at to "/o Der :annwn The DanDee Co.
hu. rs lint respons ble fur delays caused by weather, strike, material shortage lir delay in matent+l supplied to ttte job or to any other delay beyond Its control I he
nanDct: Co tnc. total liability under this cnnlfact lir in negligence it. Innitud wkly to the amount of this contract
We are fullycovered�y,.wQrkfn€n's �QRt�ga$lion and public liability insurance. Carriers n�rrtg���r� poliC.Y DiflTthefs available on
request.
any +iter; ilea lir t1(*y0li0rr from !hr a above specifications involving extra Cost of material or h3nnr will only be exocutOd upon written orders for same, and will become
an extra charge over the sum mentioned in rhit proposal All agreements must he 1111de in wf ithing and is based an free access to building tnr dlrert InaO n0 from our
uuckc
Prices are based ort current Costs of material And 1phor. Increases or da(;reases. will be reflected at time of signing contract.
Before and or during roofing operations and the completion of roofing, The DanDee Co Inc, will not he respgnslgle or liable for carnage caused front
acts of God, such as earthquakes, thunderstorms, hall or any other weather conditions beyond roofers control.
I)A I F
r)ATr=.
H IF DANDLL CO. s
ZO-d
FROI)OSA1, VALM FOR DAYS
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