9903-083 (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
732232 B , 9 8i01
t� ate i en Signature of Contractor V
kl
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).
( ) 1, as owner of the property, -&m 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.
N( ) ,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
pirr is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This seclonNeed ncit CSe co l ted if the permit valuationRis
( •) 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 provisio is.
Date;Applicant kers%107-0�
Warning: Failure to secure Wor' Compensation coverage is nlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of.the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a .permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon,whose behalf this application is made & each person at;,y
whose request and for whose benefit work is performed under or pursuant to s
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any.permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection prfr"poses.
Vignature (Owner/Agent) �1 Date -�"
i G' V
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 9"3_i TRACT
/ r
rt 2�• f ti AA1 on — s 20n1 '1
JOB SITE
APN
ADDRESS
SLS . d ARAV I%i
'UA
OWNER — CONTRACTOR / DESIGNER / ENGINEER
BROOKFIEL D HOMES SAN .DIEQ0 INC. BROO:FIELD HOMES SAN DIEGO INC.
12865 Pt71I,i'E DE'L MAR, SI JYF 200 0865 PC)INT°E DEL M.Ak SUrYE 200
DEL MAR CA 92014-3859 DEL MAR CA. 921,014-3$:
(619)481-9—VO CUP 5350
USE OF PERMIT
pis .�, i• r�,t ,j . ,r t%ra � i,...i v
LOT I9, P AN 3,-S1'<'i�- PER—MIT DOES NOT INCI,UDI FILCK," : WALL OR
P(>Of . PL-tNN CHF FEiiE R.I-I?iJC"TrD 75SS 1,OR MU'LfPLE ISSUANCE OF
CUSTOM CONS'f'CR JC" 1'1ON 1100,00 8F
t
PORCH/PATIO 519.01) ; F
0AR.A07FWARPPOR.T 72`7.00 SF
'ESTIMATED COST OF CC)W!'AUCTION
262,641.91),
IPE+ R 1'iIT IM'EE SUMMARY
CONST RC Lt TIO1QFEE 101-000d�11f3-000 $2,3.16.00
PL -air' OHEi 1 Ol-000-4139-318 $249,37
MECHANICAL %"EE 101-000421-000 $92-00
EL''W'.7R•ICA1 FEE 101.000-420-000 $180.54
PLIJ&MINC FEE 1411-000-419-000 11.92.75
STRONQ MOTION FEE - RE -SID 101-000-241-000 $26.26
f. RAOINGaFEE 101-000-4234U0 $20.00
iiM'R STR1JCt` RW FEE 2254000-40-342 $5,75=1,13
ART 1N 1'CJB.L:IC" PLACI?.S - .1Zt 31..Cj 701-000-255-4)00
..;' srry�p�
,t �yygqjy{�ryh��j � S�'�+/'�}�{ •�{'{"� flµ' ' k' �ryr�[, /^
'' 7'� CONWR Rdi:./r..�,}�S:.JLH ,;E11�71.p .K"IeF#,(v LeS"l,T..0.i 1�a
1
� ) t; t�
S�8?16 /.U..7
$8,1
APR ' LESS PRE -PAID FOES
$0.00
C r, to ^ • - •\ •,-.- :. •.:fir
�y��ry,y� y�ERAII2' .VEEN DtTEi l OIV
fi�yta Y'tU.�iS� !. �
$8,127.65
RECEIPT
DATE
y
B,
D E !AICD IiIiD�
u
INSPECTOR
.i �
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
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 99 6,6(
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 I
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 41
Pool Cover
Sewer Connection 9V23 4 4Z
Encapsulation
Gas Piping Od
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
Utility Notice (Perm)
COMMENTS:
City of La
Quinta
liq
n"14WIN
nic 11� �7
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
Owner of Building: BROOKFIELD HOMES SAN DIEGO
Building OffiEal
55-914 BRAE BURN
VN
Bldg. Permit No.: 9903-083
Land Use Zone: RL
Address: 12865 POINTE DEL MAR, STE 200
City: DEL MAR, CA .92014
By: GARY HARTMAN
Date: 6/30/2000
POST IN A CONSPICUOUS PLACE