9903-075 (SFD)"'�;+t,� LICENSED CONTRACTOR DECLARATION
v'• I -y I hereby affirm under penalty of perjury that I am licensed under provisions of
k= Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W' Professionals Code, and my License is in full force and effect.
=-) fh License # Lic. Class Exp. Date
132232 A f if 2/29/01
I Z r— Date(a• 4Stgnature of Contractor �� t
co _
J V C) OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ GO a 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)-
l ;
CV) () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
rn
aWORKER'S COMPENSATION DECLARATION
Z
o Z I hereby affirm under penalty of perjury one of the following declarations:
Lo Fcc
- p () 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
J Q performance of the work for which this permit is issued.
Q° U �(/) I have and will maintain workers' compensation insurance, as required by
O � Q Section 3700 of the Labor Code, for the performance of the work for which this
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in. H permit is issued. My workers' compensation insurance carrier & policy no. are:
?-Z Carrier Policy No.
•o� '
t� d INS CQ OF rHE STA'1 RWWO X3713576
g(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.
bate; � Applicant �L S�l 19
11L: 4
Warning: Failure to secure Workers' Compensation coverage is unl 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 it
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 p rposes.
'
4 + Signature (Owner/Agent) 1 �•• Date'-��
BUILDING PERMIT PERMIT#
DATE VALUATION LOT071 TRACT
.2o . el 5224.813.90 i 1 29003
JOB SITE
APN
ADDRESS
55-78643RAF, BURN
769-5104102
OWNER ` ` ` '
CONTRACTOR / DESIGNER / ENGINEER
1312c OKFIEi,D HOMES SAN VIEW INC"..
BROt,KFIELn- HOMES sA I :i IEGO RN:C.
12865 pC3:1N1.S `DE1'. MAR; SiTi7'E 200
129,55 Pt:iVT L"ii?L. MAR, S MI1 200
DEL MAR, CA 92014.3859
DEL NIA.R CA 92014-38'
(193)ul-8500 Cf3 9 5350
USE OF PERMIT
i•%i 's' ! M 6ff rO E' 1f T."X5
��.
LOT 11, PLAN 1, -SFDL- POWIT )DOES NOT iNCUIDE 13LOC:'_K. WiU L. OR
VOOL PL AN CrfFCK F'.frF REMIX 60 754'n FOR NfUL.IPL.F,1 WSUA:NG1.^ Or
S:AA: T? P7 AV %
CUS`.i ONI. WiNSTRUC'1:itiiN 2,655.190 W
PORCRNO TIO 302.00 S`1%
GARA.C3OCARPORT 713.00 SF
ESTIMATED CUVI' O.f CONSTRUCTION
224,813.90
1'lF"[tl<'Iff FEE, SUMMARY
C014XrRTY7rf0N WK 141-000-418-000 $1,077.00
PL.0 r'HE(-is. FEE IO! -000-439-318 5219.32
MECHANICAL FEE ) OI-OWO-41I-00(3 ST9.00
aECII-R1C:AL F02, 10.1-000-420-000 $164,69
1yL17NMING FEE 101-000-419-00(3 S185.25
Si'11ONQX10TION'FERT - RES..0) 101.000.241-000 $22.48
GING F.F : $24,40
INFRAST IX*TURF' FE1! $4,967,98
ART iN PUBLIC PLACES - .R:ri= 701,0530-25.5-000 x312.(1.3
e
" ` SCM• I011%,L CON .51U-MMN .AND PIAN CIJECK
$7,047.76
LESS PRE -PAID 141';',1;4
wi
$0,00
APR 21 1999..: TOTAI C RMIT VEF,' WE NOW
87,047.76
RECEIPT
DATE
BY
DATq FINALT,
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I ALI
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U. _
Compressor
Framing
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
O
Final
Final o/
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines S S'
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection Q
Encapsulation
Gas Piping
Gas Test
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)
FheDanDee
ROOF/NG ANIS CONSTRUCTJON
BROOKFIELD HOMES
�.: 12805 POINTE DEI_. MAR, SUITE4200
71, DEL MAR, CA 92014
II PHONE# 858-481-8500 FAX# 564-8317
TO WHOM IT MAY CONCERN.
RE,' O-HAGIN ROOF DORMER VENTS
mall •i
w }7
Roofing Pro►pc saj
17.0. Box 277 Thousand P iibyjy, . CA 10276
Phone (760) 343-3385 Fax (760) 343-3090
400.NAME:
HERITAGE COLLECTION
LA QUINTA, CA
BID# DATE 8/22100
THE DANDEE GO. INC. HAS INSTALLED THE ROOF DORMER VENTS CORRECTLY, ANIS AS PER
ENGINEERS SPECIFICATIONS AND OR DRAWINGS AT THE JOB SITE KNOWN AS BROOKFIELD HOMES ,
THE HERITAGE.
NOTICE
'llnaf,,r Iha h1@Chamu,' I it r Um fGOhfurmu Cutis: of Civil P=edure Section I 1 U I et Seq ) any coniraCtor, SACOoKv tur, laboror. supplier other person he helps to
improve your properly Outs not pr. -d tnr rima work or supplies, nog a nq.iq lu u11fuf1:1; a dalm agalnsl your property. This m2Nns that alter,i ".(ribs hMdtntp yc,ta tauperly
ooullf he sohi t:y r, ofwo of:rcar unit Ilio piwx(05 of the selc used to satisfy the indebtedness This fait nappr.n revel) tf you hitVC G'ilitl Yf)tlr (jW(r CW'dlaG4i in fun. If thri
f;utX nnhri ;lrv. I:tiMv,;i e, supnlher remains unpaid and if legal action is ner.nasary to rnllrat ,;r 60foso, tbu Wires of this ronlraca, the prevailing pang snail lht ernaaed W. us
n asonaole anorney fees plus all CnIA.4 ul Ad0 nnrj mtwegt shall iiCCrcic an all sums. which are due -M days after haling At the rate at 1A lye per minum The DarrNie Co.
mr.. 1% 1161 rygponsible fur dulays caused by heather, strike, material shminge ro nrtiny in nuttdrlul Suopllud to the job or to any other delay beyond ns cmurm r nr;
D-fltkc Co Inc, total liability una6f this contract? or in negligence it. limned solely to the arrwunt of this contract
Wo aye fully rnvaredy_wwrkrfr,',frgmon.a,ition and public liability insufance. Carver{_1??mg s��l�l.RoliG.y Climbers available ort
request.
riny OltPriibO'+ Or d0v(il 1011 f10111 11W a above spuGhCatiuns involving extra cost of material or rahnr will only hm: execulod upon vuilten orders fo(saine, and will hernr-rr.
awmia charge over the., min) owfihonerl lit this proponat ail agr6einen(a mlisi I)C made in wmilhbig and is based on (ten aCC.esr. to huuding for rtI(Ka lco m Our
KurilR
Prices are haled on current CoAm of material nnp tabor. InCeee2(D8 or detreases, will be reflected A Time of signing contract.
Before anil or during roofing operations and the Completion of roofing, Thta DanDee Co Inc, will not he reslloneigle or uagli) for c+amaXja Caused from
acts of God, Such os earthquakes, lhuneet stormo, holt or any other m3ather conditions beyond rvatere control.
Z o cl
DAl F
DATF.
I1R01'108A1. VALID FOR DAY,-.
t
3.1 1HM WO1_ c:l0Z = TO 00--? '-Orgy
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
55-786 BRAE BURN
R-3 Type of Construction: VN
Owner of Building: BROOKFIELD HOMES SAN DIEGO
Building Official
Bldg. Permit No.:
Land Use Zone:
9903-075
RL
Address: 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA., 92014
By: GARY HARTMAN
Date: 3/29/01
POST IN A CONSPICUOUS PLACE