9912-222 (CP)N_ 1)
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LICENSED CONTRACTOR DECLARATION
Ihereby 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
6_%128 C53 1 OI311201
f
VDate t ` ' Signature of Contractor
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.
('� 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 TAT1314U1, Policy No. ' fb1U--00ailb3-J9
(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;shall forthwith comply with those provisions.
v6ate: t ` Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit Issued as a result of this applicaton agrees to, & shall, Indemnify
& hold harmless the City of La Quinta, Its officers, agents and employees,
2. Any permit Issued as a result of this application becomes null and void if
work Is not commenced within 180 days from date of Issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives°of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) i ' ~ `Date
BUILDING PERMIT PERMIT9912 222
DATE VALUATION OU 7,8410.00 LOT TRACT
13�cx3
9&754 RRAE BURN
APN _
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
010010M LD HERITAGE.
CALIYUMINUA POOLS SPAS
12865 K)IN°IT, DEL NUUA , STJ1'T'.E 200
74-72:5 3C. NI DRIVE, dA
DEL. MAR CA .42014-3859
PALM. DESERT CA 92760
(70))340-90(#0 CBT.>'# 35
USE OF PERMIT
i'VOL & PA CA4L is - ALAIkikSi_8A Tt3+Btt5 SRALL BE 1N PLA(,j A`ipme,
P001. ia%rVOR SFA 1 77 W.0 LS
t 1 I
Lsl
ES17"UATED COST OF CONST RUCTION
17,800A0
KRAUT .e�U SUM_IvsXRXr
PL XN' C;HE.CK Nib 101-000-439-31 8
'Cf7t3i"t'1(Z1Jri� R. 10i f)fff!-di$ ()Ilii x1aS<i,Pr(i
MILre.,1,V41CIAL rim" -- s'.-100), 101 -OW -42114-000 124.00
E1L1,'iWCt'L FEE -- POOL 101-000-42" 00
PIAJMI.4ING,H1iE .,- 11000 101-OW-4Bx-000
SUB -"'"(n AL CONSTRUCTION AND .PIAN c,,[-1ECK.•
$407,95
T.ES.`J ./'PZ -,-P TD �tiS
0.>l0
T(YfAL PERMIT FKES DUE NOW'
$407.85
F
RECEIPT
DATE
BY
F E O
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I 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
Insulation
Compressor
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
SLOCKWALL APPROVALS
POOLS - SPAS
Steel n /1
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric LA
Underground Plbg. Test
Fina! I I
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:
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Environmental Services Division
POOL AND SPA PLAN CORRECTION
District No. 1 Plan No. Date
PROJECT NAME
PROJECT LOCATION
OWNER / CONTRACTOR r
The plans are nowapproved subject to the conditions listed below.
/
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CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre=gunite and p�rerplaster inspections at least three (3)
working days in advance. + L + J\.
J
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment, and signs.
APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTIONS and 'APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL INSPECTION SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
Plan Check By �• (J i i 1� t t Phone ( ) � . - l�C C.
/
acknowledge the corrections noted herein andas-indicatedon the.plla�7,
nnsand ,agree to incorporate them during construction:
Signature `ice \ /'�_ _ �1`�
Company L4L t zu ety, ti SLS 4. a Ps
Date 124 101 q 9
DOH -SAN -181 (Rev 11/95) Distribution: WHITE—Office; CANARY—Applicant; PINK—Bldg. Dept.
�,,y-„^{Nr�.r,.,r✓.y.r.�.;.r�,.�:+h..i..�r+�""'t �- � ((`t a ��yy �-.il+:l���'y1•s-•..s+t.....rc� �i'"r'�`�••�y, ti'„�, ��1.+�.-., r,•7,+�t,r+►.1"•C"'
""Y "� 1^�M � sJi�ywl�/^`m� �x'rY"i'M•av �✓'^� f �v �1'�f"`• }.,.. i
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Environmental Services Division
POOL AND SPA PLAN CORRECTION .
District No. a-3 Plan No. Date 1.2-11,9 A5
PROJECT NAME %rook' -(!'Z (Cl. C� ._ • A @ (/or, A (A)?C /
PROJECT LOCATION �.—S' L
OWNER / CONTRACTOR
The plans are now approved subject to the conditions listed below. 1
t/ �ln(/ l Q y -L� r4(.cyo �✓J Sa
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GO 2 3 'C� c� S�nu�� ek�eU P re
3 A s a" a;i ,2Q,����s�-�� /QST Q4-1-17 .
56 CA LdZA ` S (nc* + 0hC-s � a t { CIAA,. c COOS /c.� 1 -�
471. it, I1J,k4 U'E e t- f�/ / %l�ia (\ Z34 i) S
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3 // Gun.;1,
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a-- ocx W t Vx3M S VS -41' 01\,S OM '5/ S'o n 1000
, t,. 0,0 o j �d n� r c� 44� • f c� . to � to Q � -�f o A SS G
7�1k C94i
CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least three (3)
working days in advance.
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment,. and signs.
APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTIONS and "APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL INSPECTIOJN SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
b
Plan Check By �• (/ lJ� Phone
1 acknowledge the corrections noted herein andas indicated on the pl ns and agree to incorporate them during construction:
Signature
Company CALIFO R -NIA
" Date
DOH -SAN -181 (Rev 11/95) Distribution: WHITE—Office; CANARY—Applicant; PINK—Bldg. Dept.
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM # DATE
SUBJECT P ERMIT NO.
ADDRESS u
INSPECTOR
AA -,j f Ju r �A I
DEH -SAN -118 (Rev 2196) Distribution: WHITE—Office; CANARY—Owner; PINK—Office
`
COUNTY OF RIVERSIDEHEALTHSERVICES AGENCY
DEPARTMENT OF/ENVIRONMENTAL HEALTH
' ENVIRONMEVTAL HEALTH SERVICES
t
SUPPLEMENTAL REPORT TO SAN. FORM # DATE
SUBJECT K(�nK�TT"�%1 �- . w• �6N `�/�S' PERMIT NO.
,
ADDRESS �rG �eL r"V�
INSPECTOR
REMARKS:
V
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DEH -SAN -118 (Rev 2/96) r , ,,.,; , i Distribution: WHITE—Office; CANARY—Owner; PINK—Office
COUNTY OF RIVERSIDE 'HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEME NTAL REPORT TO SAN.FOM # DATE
SUBJECT 1 C, PERMIT NO.
ADDRESS, 76-c/ Ar 0,-e- Q. VLA L
;REMARKS:.
'INSPECTOR
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DEH -SAN -1 18 (Rev 2/96)
Distribution: WHITE—Office; CANARY—Owner; PINK—Office.,-,�.
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM # DATE �C� v
:SUBJECT C PERMIT NO.
1. ADDRESS S �� U�I u CRam.- - L .
REMARKS:. C.`
INSPECTOR (C/
c.lz Qqo
6
DEH -SAN -1 IS (Rev 2/96) Distribution: WHITE—Office; CANARY—Owner; PINK—Office ;
The DanDee
tksy hx•. 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 Pahns, CA .91176
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 ANQ OR DRAWINGS AT THE JOB SITE KNOWN AS' BROOKFIELD HOMES,
THE HERITAGE.
egg 1,4 D4.,- ,O%2Ei4
LOTS # 2001-2017 BRAE BURN
LOTS # 3001-3019 BRAE BURN
NOTICE
'under the Rgerhnnirs' t ten Law fCohfutola Cude of Civil Ptocedute. Section i 181 ei Seq ) any cnntrAr,.lor, Skftontij, uV, laborer. supplier other person he helps to
improve your property but is not pard for his work of st>pplies, hos a right to unfurce a claim against your property. Tris means that. after a riiurl he0ntig Vow urupully
could be sold by a eoun ntarer and Ihre pito r:r:ds of thu soli, used to satisfy the indebtedness This can happen r:van if you htwe glint your own convacvv in full. If the
;uncnnh:,rtnr. 1',IWrcf cii supdiei remains unpaid and it legal action is neressafy to rodent br enfoiCv thu trams of this contract, the prevailing party shall be entitled to its
reasonable attorney fees plus all costs (it gpd ring interest shall aCCI oc an all sums. which are due 30 days after trifling at the rate at 1A % ger anittim The DitnDee Co.
hu, is nM responsible fu( duluys caused by weather, strike, material shortage nr da, ay in material supplied to the job or to any other delay beyond its control t he
ntarDcc Co Inc. total liability under this contract or nn nf-glfgenre it Inuit@d suluiy to the amount of this contract
We are fullycovered�y„w4rkmQn s gQ(ln�en9s�(ign and public liability insurance. Carriers n,M�,��golic.Y Ill+mbers available on
request
Any ;tuerM10,1 or (l(-vialtorr, Horn lho a above specificativos involving extra cost of material or lannr will only be exoeutod upun written oideis tot same, and will hernma
an extra charge over the sum mentioned in rhis proposal All agrPeinentS inuStbe iltade tit wlilhing and is based on free access to building for duan moping morn our
InrrnS
Prices are based on r_IIRP.ni costs of material an(i 18"1”. InCre8808 or doereases, will be reflected at time of signing contract.
Before atilt or during roofing operations and the completion of roofing, The DanDee Co Inc, will not he reyponsible or uai)le for vainage caused from
acts of God, such as earthquakes, thunderstorms, hall or Any Other weather conditions beyond roo(eru control.
0A'I F'
DATE
I'll[; DANDU CC).
)'ROI"OSAI. VALID YOR DAYS
ZO'd 3.lIHM W01 dOZ:10 00—ZZ-6nV