9903-071 (SFD)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
// /32232 B 21k /01.
f�at6 L]y ?,1 ^ 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.
J) 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 Policy No.
INS CO OF THE STA.'1 RM.WC 347-0526
(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: - l Applicant 1
/Warning: Failure to secure Workers' Compensation coverag�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 tlie 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. a{
1. Each person upon whose behalf this application is made & each person
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicator agrees to, & shall, indemnify
r & 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 pyrposes.
Vlg
It
nature (Owner/Agent)AV
A'� � Date —2•J'
t {�
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 991)3-07 TRACT
28341-2
JOB SITE
APN
ADDRESS ._ki -g39 UAF, ff1
769-7.0-1146
OWNER - '
CONTRACTOR/DESIGNER/ENGINEER
BROOKVI LD HOMES SAN DIEGO @iC.
BROOKFIELD HOMES SA IN DIEG0.1NC.
12865 LfGKrE DEL A4AA, 200
12865 MIs E DEL MAR, SUnT 200
DEL htkR CA 92014-38
59 DEL .'NIAR Cit 9:2014-3£1-'
(619)481-11500 CBL,# 5350
USE OF PERMIT
LW. 15, PLANI, -SFi+t-PERMIT t'3f:)ES NOT INCLUDE BLOCK WALL OR
POOL,1ai,AN C14EC1K FIFE REDUCED 750M 1:OR .Y WLT.IPf.;E ISSUANCE O
SAh4E PLAN TYPE.
CUST01b1CONS IRUC"NO,N 2,655.00 SF
PORCRIPAT1..O 302,00 S1=
41ARAQ0CARPORT 713,00 SP
ENY"MATED COST Of Cti1V4'N'RVC 1` ON
224,815.90
FERh111T if+.'EE S(1t1'I'WIRY
CONS'1 {[FICTION .FEE 101-000-418-000 3.1,077.00
PLAN t;:#•MCK F& 101-0004339.318 $219.32
A&04ANICAL FEF.- 101.-000-421-000 $79.0
ELFC-MICA,. FEF 101.000-420-M $164.69
iaf.I XJBINC,;,FHE 101-000-419-000 $18.5."..5
STRONG MOTION FEE - REWD 101-000-211-000 522.48
RADJNC3FEE 101-00{)-423-000 $20.011)
.1 _A47'RUCTURE 225401106-443-342 34,967.93
ART TN..PUR[:[C PLACES - RWSI 701-000-255-000 33.12,04
:I
gSkT TgrAL. CONSTRUCTION -AND PLAN CHECK
.$U4770
• 9,,�j1 Ll4S$ PR1-.k�'A.71).l'TE',S
t p
APR 21 1999
TOTEM: i'CR1�IT 1FTES DUE NOW
$7,047.76
l
IY�iT1
0F LA0U��
1.
RECEIPT
DATEBY%
DtVZft
INSPECTOR
4�
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
0. K. to Wrap
t
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
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
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
ea
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
Utility Notice (Perm)
COMMENTS:
ti
_,�_,.�.,�' y Mi "�i'i rte:�1+/iYi'l'4+efl�•"`tS-f."�"�i^+!`....�r���' �`at�r,�..�` t t • %�;—�
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: 55-839 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9903-071
Occupancy Group: R-3 Type'of Construction: VN Land Use Zone: RL
Owner of Building: BROOKFIELD HOMES SAN DIEGO
2-40-1k
Building Official
Address: 12865 POINTE DEL MAR STE 200
City: DEL MAR, CA., 92014
By: DANIEL P. CRAWFORD JR.
Date: 2/22/2000
POST IN A CONSPICUOUS PLACE