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LICENSED CONTRACTOR DECLARATION
'I hereby'8ffirm 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 '
X7��i3�
Date �- 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.
( y 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:
Cartier Policy No.
(This section need not beNcompleted if the permit valuation io �OOOOOor 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
9de,, I shall forthwith comply with those provisions.
Ipat� 7�•� :q Applicant
Warning: Failure to secure Workers' Compensation cover ge 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 inspec Ion purposes.
ig ature (Owner/Agent) �` t Date
i
BUILDING PERMIT PERMIT t/
DAT ` I VALUATION LOT TRACT
S262.641.190 29141 t*�
JOB SITE
APN
ADDRESS
OWNER _
CONTRACTOR/DESIGNER/ENGINEER
BROOKFIELD HOMES SAN DIEGO INC.
BROOKF'IELD DOMES SAN DIEGO INC.
1286-5 POIN iE DEL MAR, SUITE 200
128651'i3Ii TE Divi. NIAk SUi'lCF 200
DEL MAR CA 92014.3859
DFL MAR CA 92014 -:'ti:
(619)431-8400 CBL# 5350
t
USE OF PERMIT
t11.`1 �f ILi }L' •. FY ' U � 1'l ti,7
I.(Yi 12, PLAN 3, -M-) .PERIV 11 DG93 NOT MCMDE BLOCK WALT, OR
PG3ol-
MSTOM CONSTRUC HON 3,100.00 S1=
PO'RCY-PPAT.IO 5.1.9.00 SF
GARAWC ARPOR`!' 727.00 'IF
F;STIMXfPDCOST OF cON.S•.rKIUL"7°r.ON
262,641.90
PRRJ&f' Illi f StIMMARY
CONST131:I'C7,10N13-3, 10;1-000-4111-000 $1,210.00
PLAN MECK.FEE 101.-000-439-318 $981.47
M1.,t' MANIC AL FEE IOII O-421-000 592.00
ELECTRICAL FRE .10.1-000-420-000 $180.54
PLLIMJ3 O 'FES 101-000-1119-000 $1.92.7.5
S`I`RtONGt.MC TION 14-13 - RESID 101-000-241-000 $26.25
GRADING FEE 1.01-000-123400 $20.00
iNFRASTRUCTURE WE 225-000443.342 $5,754.13
ART 1N PUBLIC PLACES - REST 701-000.255-0110 $•406.60
a
SU 3-TCrTY,L C:ONS`TRUCTION AND I'1n.AI'4 c:'HE1CK
$8,863.75
LBS PIMPAID FEES
$0.00
TOTAL' MIT FE.CS :DUE'NONA"
$8,863.7:5
APR .21 1999 1
RECEIPT— ^ —
'DATE 1 I —
BY }
D T LE
INSPECTOR
3
n
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs i A
Underground Ducts
Forms & Footings
Ducts
Slab Grade 1,7Return
Air
EA
Steel
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
F)derior Lath S
Drywall - In . Lath
Final
Final
BLOCKWALL APPROVA
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 ZW Z,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 7SDO
Appliances
L
&A
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) W&T W. V
Final
COMMENTS:
I
Certificate of Occupancy
City of La Quintal
Building and Safety Departmen't
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: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
55-791 BRAEBURN'
VN
Bldg. Permit No.: 9903-068
Land Use Zone: RL
Owner of Building: BROOKFIELD HOMES SAN DIEGO Address: 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Building Official
Date: APRIL 3, 2000
POST IN A CONSPICUOUS PLACE