9903-067 (SFD)It)
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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 Bnmi
atell- y,a 1--9Signature of Contractor ` /t
V, �rt v ._
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).
O 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,' I Policy No.
(This section need of be completed if the permit valuationRMW is fforr $100.00 or Mess).
() 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 f revisions.
Date: a • Q Applicant s`� A t
i /fit 6*
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 condition_ s 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
thbove-mentioned property for inspection purposes.
X41"gnature (Owner/Agent) � � t� 1 i Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT -volll-067 TRACT
CC SZ24,815.90 oad, :8:341 __'
JOB SITE
ADDRESS d 4�►= .
3iAE Ajswt
APN
769-510-014
OWNER _ CONTRACTOR/DESIGNER/ENGINEER
BROO ' ,IELD HONIES SAN DIEGO INC, BROOKNELD EI.OMES SAN DIEGO INC.
12W POINTE DEL MAP, ,QUITE 200 1-2965 Pi'31Ar'i'C DEL mAR, Surra 'mo
DE L NIAR. CA, 924.14-38 59 DEL MAR C.A. 92014-3f3:
,619)481-8SG13 0811# 5350
USE OF PERMIT
!�Ifqot V VA klil V r)Ims f' m1 l
LOT 11, MAN 1, -SFD- 3%IM4I1 DORS NOT MCLUDF BLOCK WALL OR
POOL, '
:MON. 2,655.00 Spry
7C�US�•r}�i(t�'ty'l��t[�Ov}N�S'i°RU
.!'l.�l CHIP A 1 LV M2.00 iS
GARAGEWARPORT 7.1.300 SF
ESTINIA.TED COST O1+ C6N3i,1WCI`.ION
224,81S.90
PERMIT FEE SC:r14'1111 tRY
C ON'ilRUCTION FEE 101 -OW -418-000 $1.,0'i'.Cli1
PLAN CtWCK FEE 101-ti00-439.318 1877.29
MECHANICAL EE: 101-000-42.1-00 579,00
ELECTRICAL FU tOl-000-420.000 $1464.69
PLUMBING FEE 10.1.000-419-000 $185.2.5
S:I'RONG N19CION FEE - RESID 101-400-1-41.000. $22.48
GRADMG E'er 101-000-423-000 SNi1.00
`iWl?ASTRUCIluke 2T,_E 225-000-443.342 S' 061.98
ART 1:N PUBLIC PLel.C83 RE 311: 7014)0-.255-1100 $312,04
>. It
CONVIRL IrlON AND PLAN CkLiCK
S7, Q .73
' _ LESS .PRE -PAW 11:1:5
$01.00
APR 21 1999
T.OTf T, "R149IT FELS DUE NOW
57,705.73
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RECEIPT
DATE *ti
BY.`
DA ALED
INSPECTOR
Im
Q
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
S
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
D all - Int. LathIg
17
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
S'
Appliances
Final
COMMENTS:
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)
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 fol%wing.
BUILDING ADDRESS:
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
55-775 BRAE BURN
Owner of Building: BROOKFIELD HOMES SAN DIEGO
Building Official
Bldg. Permit No.: 9903-067
Land Use Zone: RL
Address: 12865 POINTE DEL MAR. STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 4/30/01
POST IN A CONSPICUOUS PLACE