9903-069 (SFD)F—
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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 8 , 2/ Ol
p t,� C 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).
O 1 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:
Cartier Policy No.
(This section need no bef completed if the permit valuation issffor $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.
Date: �' Applicant •�'s /. �—
Warning: Failure to secure Workers' Compensation coverage isytinlawful 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
y 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) t ( Date�� -
BUILDING PERMIT PERMIT#
DATE VALUATION LOT5941.3=069 J TRACT
t;- • J.0 $262,641.90 ! i 233,411-2
JOB SITE
ADDRESS�-»,
i B71i!RN k
APN
769-310-01.4
OWNER CONTRACTOR / DESIGNER / ENGINEER
aROQUIELD HOMES SAN DIE00 INC. 13ROOI'NELD HOMES SAN DIECY3 INC.
1.28165 POINIT DFA. MAP, SI)1 E 200 12865 P011WE DEL MAR, SIATE 700
'DEL IVLt'152. CA 92014-38 59 DEL IViA1;L CA 94014.38_
(619)481-4500 CBL# 5350
USE OF PERMIT
S i ' 3
LOT 13, PLAN 3, -Sr-D- PERMIT DOES NOT INCLUDE SLOCK WALL 0R
POOL, P1, AN CRECK:F'!! 1s'REOUCFly 73% FOR MULT1T'LE ISSUANCE OF
CU'ST04 CONSTF VIC T AO:N 3.100-M 31'
Pt.]RMPkTit3 519.00
GA RAGWC4RPO.R.T 727.00 S)"
1✓�JT1.1�1r�1"i.l3ID COST or (.'`i3Nb'i'RUC'1•ION
262,64, 1.9t)
PERI IT SEE SL1.A1A4rSRY
CONST1t1JMON FEE 101000-418-000 11,210.00
PLAIN t; HECK iFFJ--' 101-000-139-3123 SZ15.37
NIF04ANICAL FFIS 1014000-42.1-000 $92111N)
EL1+CrWCAL FEE 101 -000 -420 -OW $130.54
PLU BIXOFEr. 10.1000-419.000 $142.45
STR NO MOTION FEE - R SID 101-000-241-000 S26J.'26
GRADING FLEE 101-(100-423.000 520.00
iNFRAN' RUCfUREFER 2263-000-443-342 $5.754.13
ART 1N PUBLIC PLACES -.RHSTC 701 -000 -255 -ODD &106.60
.t
1
1113, IIwAL CQNS"`#1IUC!"1C:11V AND PLAN CHECK
$8, L l o
L.l11 Pi IIPA�W FEES
50.(10
APR 21 7999
TOTAL PERMIT jFE`ES ;DUE NOW
$8.127.65
RECEIPT
DATE
BY'
DA F
INSPECTOR
z�.
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
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
D II - Int. Lath
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 allPool
Cover
Sewer Connection 0177717
Encapsulation
Gas Piping
Gas Test 715-1
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
guilding 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: 55-807 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9903-069
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: BROOKFIELD HOMES SAN DIEGO Address: 12865 POINTE DEL MAR, STE 200
Building Official
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 2/24/2000
POST IN A CONSPICUOUS PLACE