9903-079 (SFD)C
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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
AteL!- "? o-1?4 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:
( ) 1, 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.
( ) I have and will maintain workers' compensation insurance, as required by
Se�CUon 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 be completed if the permit valuati( ; ffbr 100 0005
r Pess)
( ) .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:ys� Applicant /0
`r V r I LIL. cic
Warning: Failure to secure Workers' Compensation coverage is up awful 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.
1 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. 1
Signature (Owner/Agent) ,1. / ,/ Date II"' "1 ��'
BUILDING PERMIT a PERMIT#
DATE VALUATION LOT �y9tF -077°- e TRACT
t . fr2za,r1� s.l r. 2900:
JOB SITE ' t .,
APN
ADDRESS �.
ti #i 31tt _I iI3_Itti;; i
769-536 007
OWNER CONTRACTOR/DESIGNER/ENGINEER
BROOKFIELD HOMES SAN DIEGO N. C. l3RO00ML D HOMES SAN DI.CCTO WC.
12865 P011M DEL MAR, SUITE. 200 12865 I'C.9OME DEL MAK SLUE, 200
DEL MAR CA 92014-31159 DEL MAR C A 9201/1-3131
(619)481.-8500 C'BL## 5350
USE OF PERMIT
L(YT IS, PLAN IR, -3rD- P.MMT UO.RS NOT INCLUDE BLOCK. WALL OR
POOL, P1, AN C.HECK'M, REDUC III) 7,5% FOR M11014,lE ISSUANCE OF
f, P1 A t4 TW17
CUSTOM CONS1`RUC NO.N 2105.00 Sr
POR.C7I1P010 302.1+0 SF
GiA#LA+: WCARPORT 713,00 SP
Li'SSTINIXFED MST OF WNSTRUCT 101N
2.24,815.110
PERMIT FEE S'L AMARY
CONSTRUCTION FEE 1.01 -000 -41.8 -OW $1,077,00
t'.Lr' N C1 WCX C.EE 101.••0W-139-318 5219.3?.
MECHANICAL FE 101•-i1W421-000 $74.00
EL.F CTRIC".AL FEE 101.000-4'20-000 $164.69
P11M f13ING F3 101-000-419.000 .$185.2.4
STRONG MOTION PEE - PWSID 101-OW241--000 •-000 522.48
0R-ADIN,ai"1 i 10.1-000-423•-000 520.0n
INr,Ib"T-kLiC'i°"f.)12,1.1 i?H; 2215-000-443>342 $4,967,98
ART 1N PUBLIC PLACES -FLI: �`+'I%, i 4.1-t1U0-^c 5°�-i)0q $312.04
•
R,
STLIB-TMAL C NSUU'G"1; MON AND PLAN CHECK
$ ,047.76
4� I.E,SS PRE -PAID FEES
$0.00
APR 21 ToTAL rrmhtif€e gEs DUE NOW
s7,047.76
.1999
RECEIPT'DATE
+. u 'v BY/ -
DAYE NALED
INSPECTOR
x
D
V/ I � %.. Yom- -0 ►'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs IA16
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
Drywall - Int. Lath
Final
Final
BLOCKWALL APPRO-VAL6
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 Q
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:
PW
Certificate of Occupancy
City of.La Quintal
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:
55-850 BRAE BURN
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction: VN
Bldg. Permit No.: 9903-079
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: 10/27/2000
POST IN A CONSPICUOUS PLACE