9903-070 (SFD)yU) y
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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
3223'' �;01 A
t,,Datu d`�`�' Signature of Contractor ` 1
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,.wiII 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.
(�9 1 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 Policy No.
INS CO O1 Tim vm0`t^
(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. "
Date:Ut '�O'' Applicant 1,,41 &> ` '
Warning: Failure to secure Workers' Compensation coverage i, nlawful 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. f
VSignature (Owner/Agent) Date
PERMIT#
BUILDING PERMIT
DATE f f VALUATION LOT '0""10i� TRACT
$241,839.20 14
JOB SITE
APN
ADDRESS
j55-023 U&NE RURN ,
369-51"14
OWNER - - - .- " CONTRACTOR / DESIGNER / ENGINEER
B'P,00KFIELD MONIES SAN DIEGO INC. B&OOK.PIELD HtaMES SAINDIE, GO INC.
12865 POINTE .DET MAR, SATE 200 12865 POINTE DEL M,AR, SLln-E 200
DEL MAR CtV 92014-3859 DEL MAR CA, :92014-38'
(61, )481-1.35110 CBLO 53.50
USE OF PERMIT
LOT 14, PLAN , -SrDI40"T DOES 140T INCL UDE tai OCK. WALL OR
POOL..
C UST(Al CONS`.Ct<tI T.(ON 2,872.00 SF
P0RC1VP,KT 0 364.00 S1-
GARAO CAtzPORT, 677.00 Sr
&S'1'.iMATED COS'D OF (:(MOSTi1<:UC'[iON
.241,#39oZ0
Mi Ri1i ff FEE :�i;fMINtA i t'
C0N'. TR1JC-T1ON FEE 101-000-418-000 a73n �:aO .ri1
PLAN CHECK T•! , 101-000439.315 Sr3N1.f;E3
M1d.".:`1. ANICAL M" 1.01-000-421-000 $115,50
P-LECtRICAL FES 101-000-420-000
PLUMBING 11F 3111=000-419-00)
.31'Rfi,3-NG;Iv10TION FEE - RESID 101-6W-2141-000 $24.18
<AA}21NG .FEE 101-00-4.23-000 520.00
1NFRA."+'1 UC CURT )FELE 225=000-443-342 S5,332,46
t#I;"r Of PTJF9i.CC:171—AC'EWS - RESIC 7,01-000-255-000 $3554.60
S
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1 SUB -"l fut' A1,, C:� NIE-444 UCTION A�jD PLAN C.'H.x:�CK
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LESS I%1�i:-P�AIU FEE
Rb
�51.11ii
APR 21 1999. TOTAVPEMIT FEES DUE NOW
$9,.225.73
RECEIPTS d b tl
DATE
BY
DATI ��
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I.A
Underground Ducts
Forms & Footings M11 A
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
Dryoll - Int. Lath
Final
Final
BLOCKWALL APPROVA S
POOLS - SPAS
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
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 Z j41
Utility Notice (Perm)
COMMENTS:
L;urtiricate 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: 55-823 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
Owner of Building: BROOKFIELD HOMES SAN DIEGO
Building Official
Bldg. Permit No.: 9903-070
Land Use Zone: RL
Address:
12865 POINTE DEL MAR, SUITE 200
City:
DELMAR, CA., 92014-3859
By:
DANIEL P. CRAWFORD JR.
Date:
2/18/2000
POST IN A CONSPICUOUS PLACE