9812-201 (SFD)LICENSED CONTRACTOR DECLARATION
U) I 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
WProfessionals Code, and my License is in full force and effect.
O =) M, License # Lic. Class Exp. Date
r; Q LO
LLJ
Z r-- Date Signature of Contractor -47y,
O
J U C:) OWNER -BUILDER DECLARATION
L1.1 Lu I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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).
LO () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
0)
ZWORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
LO �Z 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
m� Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
CL rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
`t Z Carrier Policy No.
Cb �
� C1
TNS 00 O' THR S 7 Iti 7-OS"eb
J (This section need no be comp eted if the permit valuation is $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 3,7400 of the Labor
Code, I.shall forthwith comply with those p••rovis' ns.
/Date: Applicant -•'17
Warning: Failure to secure Workers' Compensation coverage is unla ul 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 inspe tion.purposes.
Signature (Owner/Agent) �.L/ Date 2��'
BUILDING PERMIT PERMIT#�
DATE, VALUATION ' LOT � �,t!r2� TRACT
, -� . 21. $262,641 90 .7 283x11.2
JOB SITE�y� Y y�*
ADDRESS �7� 6J1Rt]L'r..BVffl
APN
769-510-002
OWNER CONTRACTOR/DESIGNER/ENGINEER
BROOKFIELD HOMES SAN DIE -00 DIC BROOKFIELD HOMES .AN DIEGO INC.
12865 POMIE :DEL MAR, SUITE 200 1218,65 P01N'I'F DEL MA -P. S(.Pt'M 200
DELMAR CA 92014- 59'..- DEL MAR CA 92014-38`
(o19)481-8:540 C'BL# 5350
USE OF PERMIT
LOT 7. PLAN 312. 9F.D - PERNT DORS NOT INCLb3?E BLOCK. WALLS OR
POOL, PLAN 04F'CK FRE R.1F,IDUCED 75% FOR MULTIPLE ISSUANCE OF
S iw, . AN TYPE
CUS'ToNt CO NS'.1'RUCTION' 3,100.00 SF
PORCHit kTIO.- $19.00 SF
GARAOF)CARPO.RT 12",-00
ESTIMATED COST Or, CONSTRUCT ION
262,641.94)
PERAlff FETE SUMMARY .
CONSTRUCTION FFE 101.-000418~000 %1,210:01
MAN CRECK'FF.EE 101-400439-318 $245.37
MECXiANICAL FEE 101-000-421-000 $92.00
I~,LE('IRICAL FEE, 141-000424-044 $180.514
PLUI1MING FEE 101-000-419-000 $132..75
STRONG NIOT•ION!'M- RES LD 101-000.241-040 $26,26
ORAD; NG FEE 101-000-423-040 VaO.Olt
rNFRA31RUCi't!RR FEE 225-000-443-342 55,7.58.13
ART IN PUBLIC PLACES - RESM '701 -WO -255-000 S406AO
SUW.MAL CONS'1'E1UCI' ON AND PLAN C1• ECK
$8,127,65
LESS :PRE -PAID FCC, S
$0.0()
TOTAL PERNIff FEES DUE, NOW
$8.127.6:
REGEEII�T9 J
X
DATE
By }�
�J
AL
INSPECTOR
I
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 D
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
iG
Final
Final
BLOCKWALL APPROVA S
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
55-706 BRAE BURN
R-3 Type of Construction: VN
Owner of Building: BROOKFIELD HOMES SAN DIEGO
To -+n
Building Official
Bldg. Permit No.: 9812-201
Land Use Zone: RL
Address: 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: '1/16/01
POST IN A CONSPICUOUS PLACE
J 4
The DanDee
Cu>t>*>ty bx% tic 732542
ROOF/NG AND CONSTRUCT/ON
Roofing Proposal
P. Q. Bax 277 Thnusanel Palms, CA 9227.5
Phone (760) 343-3365 Fax (760) 343-3096
BIDS TO ; ,SOB NAME: ,-�
TRANS WEST HOUSING, INC P.G.A. WEST HOMES
78-401-F HWY 111 P.G.A. WEST AUGUSTA PHASE 4f'
LA QUINTA, CA 92253 LOTS # 1.51.5,24,49 LA QUINTA, CA 92253
PHONE 771.3363 FAX 771.9077 DATE 12-7-00
If a 1r-W:fie 11, I pie]; ?A
a a : •a
NOTICE
't!•,00, Ins Mernan!cs' t N1'1 Law (California Code of Civil Piuwt)uro. 9otton i 10 of S0t7. ), any con!rpclor, ilbgontr"tot !o borer. rutnpoar nrllar persnn n l halpt to
mlp;.tr your Pooerty out's not pejo tot hit work or tupplias, has a right !o enforce a claim against your property. This rnvans Ittaa c
l. otter uurt hCunnp your prnpeny
Cou!a Do to:0 W It coon of of 'and the pful;uLaS Of Iht Satt tr1Ed 10 %611* Int IndetilennP..n1 1 MA ran happen even 11 ynu have part your own curlltwty ;n lull !t UR'
a:rn:varm: rAcorer nr supplier remains lalpald ano If legal Action is nocossary, to cWleot w UOIV Ut ]IV !nano Act Irus Cnnlrart, inn prrvau-119 o8ny 1111811 oe entrnec !o Its
100301%al" eM1om61 f�1 0111A an MA1a of 81111 AM interest snail accrut an ad sums wr,ich are clue 90 doyt oRvr tmmng Act lit: ruin rel le N liar Arron; rhe oanoee Co.
Inc. q nor "IWonalpte tot oelWa Wtrsed 5y wealhor, alnhr. mtlenn
rra! shagt or delay in material supplied to Ih.a;ob of to any ;fou, uelary uuyo•rrl ern
ra'nlfn:f !ne
0enure Cif MC trxal l:nnmry under this cont aal or in negligence Is limited solely to Ilia anwvnt ut this ConVOct
We a•e fully covered by wo.rJuTjuij-r,.omD*n&atfan and oublle Ilablllty Insuranco. Carriors names and poli,y rLN@tZOr: ry il+)tflq.ofr
fs;RuesL
Any arteratron of ga.:7;wn nurn Int- r, 9tA)v6 606d,nfts6ona lnvnlving axtra rntt of material or tabor will only De executed upon •M. -tion cx Uors io• sitwtt at -A will MCOM6
A" e,fra crurgo over me tum mentioned in this drtfoostal All jryrevrf'003 must lw fnnde. irr wrdhnl9 M1d it neaea or,. true attest to oviotng for arra Oa1)1rYJ 6ufn Wrr
Prlr.ns art MMI on current costs of material and tabor. Increases or decrveses, will bef renocton al limo of signing contract.
Before and or durtcg ruunng 000ranons end the completion of roofing, The DonDee Co Inc, will not be responsible or Mable lur tlamagn causer !rom
acre of Ood, Such as earthquakes, thunderstorm S, hall or any other weather conditions beyond roofrn control.
DATF.
kt*t�.--w I ) A 11: /o — 7 —V Q
fill.
ZO - d
99L0£is£O9L
Act. LMON LULr y91:6O 00 -LO -00O
L �
JAN -19700 WED 12;41 2 FAX N0, 4550212
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P. 05/05
06/26/2000 13:39 9097360018 STEEL T PAGE 03
J
,s Installation Certificate: Residential Q( �q.�,,, '.,.c►t+:�:.. •,,�� ...R;
•� .... J;.. IG:..: ..6.,:11 C. ��: 9/.''`, rn. � ,
U6661 thl■ larwr to ■■tLty tl►e rerfu4■rn.na s0 rlra Adialri■tratl�a Coda k epUoraai, trail the .t ,i� pletrMti�i and t t ;
An inatalWbn co rtltte:te is regWnd b bo pt;►aled tl Me 1jttAdtrtp tilts prbr b tlu �wtoott d iii` Irrd; 'Thb lona
may be used to most these roquirome tta. NAIW below n '110Mill Ii00� tlt�i '
tho efta neY and type Of the appQattoe ka � led Mw W ar bow Oi 11 to d 01111111 Crete d
Cvmp(lanp (CF -1R). This artMkase jor ki egUMll�tM) al�pued and � W tl o Ovea(I
responsibility tot the app wce Inat"lart.
1, the undemigned, vw y that the oqu'lpmeto fted in the CM6M WWO E0411
n (ti"ttICRt11iI "*atetff ktaltded atld
that the equipment moats Or oxceeda the Mquhmeft d t o Applk= Eal�ldatjt. M adt#kl^ i baa veil W OW
the Kuipmsm Is oquivalvd to or Mfg oftlard than the" am IpttiladCUI 0111 d CoapUarr+wlwRW b
demawrale compbaneo with the Enemy er'dwwy sum=11w rel www WWOO .
1lv..e VaTLMs
Nae: Hydronic Dello► Irdarmation is entered herr. Other hydttutla oraotrlblrted hydtrrOb equ ruant bbead Wider '
Wrist Heating 5yst4ma.
NeaUna 4ulp. CEC
Jt G CAn�lro 7Dl2rlbduttn O erTy" (imaoeddion Ribis
�host um eta Uode1Numbs► APULs LL astV - �o+td
h
.ieCd q.Z -
c tse,ar�
CEC cartHted
c4alln9 uip. campresarr Unit Actual OLdti.Sutlon Ot;iaa or
7:P+ (alr cw%d_ Usnut. Maks i
here purssp, sial KoCel -Umber
tet► L i 7.• !"" .
t
I no *uwwlo asahn hen IQ" Lid design haat q� W8 r� have !$41d4 bow gdtttil�tai_ �ifl� fit 6idids 4144h) a
i,ltl Ftwily Fl anr� oa 1r 1. Imre are iwa W ika i:l{..' ...wi I... _yvtrw6%w4& U"y W%J I.WA6n.
wawto Orr WVAC SUbW dW (C0. f4at w)w OWmW C.e*ftW orOwner
WATER HEATING SYSTEMS
Water Hsating CEC Cartltled Plated/ Tank
sysum Type Usnul. Usk* Z Input (kw Capa��yy llawvary
(sleraae ase, ste-1 Uadol Number er aft Ih%
1, far small paa storsps (titled inputs 76,000 BUM a(epUb rnistanoa and tigp
fat W il. v �s s 4it arts Ysi� bss<tsn Intaa tnD411 AI.ti00 fW4tr�, "fit Flat�l InNa
"..44 "www aw vwdR LMM6
Ow vletsntahsat 0 We water h26We. ht Rated input aM Rottwwy u1cwW,
For Instantanra►s e4"010 tnaisr ttartan, rat RWW input
;AUCM L CHOWM 11CAOO
An ILmots and showerhetds OtaWled are lined in the Commhston's Olt Oaq 9( 0431M FIUMN WW Offmot awle4
OVU rd to Title 84, Part 6, SubmVtsf L 38r31on 111,
+1iv�re _ y
altAowwsalr Ms. fum)wOsnewrcoetenrwomor
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