0312-241 (SFD)79780 Amalfi Dr
0312-241
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
i 128d £3 M7 Sri I/
Date 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.
( ff 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 REPUDIC IN17T?NINIT Policy No. 15671602
(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 ULLab6orCode, I shall forthwith comply with 1 (ose provisions.,,Date: 1'^ (){- Applicant 4 1, '__`
Warning: Failure to secure Workers' Compensation coverage 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 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 o'r 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 pur,os s.
Signature (Owner/Agent)' ` 1 v Date
BUILDING PERMIT PERMIT# 10
DATE VALUATION LOT 0_312-241 TRACT
i7,, Q12.,1it '35 29323.1
JOB SITE APN
ADDRESS `I9'_780 AM Ln DME -38"23
OWNER CONTRACTOR / DESIGNER / EN (NEER
PONDEROSAHOWS 11, INC. PO14i'.> ERO AHONMI H WC
400 0, VARI LDRIVE, 9I'li:, 33203 400 . FAY DR ►`iI.1 BB 1+33
PALM SIM.NGS CA 92264k PALiA2'ifRrJ13G3 CA 92262-
(703)187 710 C 1b 2346
USE OF PERMIT
ORKI .Y,Rf4MLY DIVMX12,TCi
SKO • Lx/'1 1% PLAN 2Ae R. PERMIT DOLS NOT INCLUDF. SWCK
WALV,, POOL SPA OR l7RNEW,AYAk'P€ OACH
IIIIIIIIIIIIIIIIIIIIIIIII 49
IE
TRACT CONI TR.UCTICN 3,838.00 SF
PORC✓MA.TIO
397.40 :3I<
CIARAfllCllRPORT
671,00 SF
Fal- 1KEED CO SKT-O + CCD.LVYA' UC'1143M
172,4W2,10
CONSTRUCTION FEE
101-000.418400
$895140
PLAN .CHirCX roc
1 Q1 Ot20-t.39-312-3
$794.56
ME+CHAWICALFEE
101.000.4.21-000
$105.00
9I.,ECTPJC'AI.. ITZE
101-013.420-60A
$146.25
FLUMBINO Fin?,
101.000.419.000
51900
STRONG MOTION FEZ - RESID
101-000-241.000
$1'%2
f; fRA.WNf31:U .
101-000-423-000
$15,00
DEVELOPER IMPAC -Ir PEE
$4405.00
( A LESS PRL-PIAID? i $0.00 U;7 ew 11RUC1101; AM PUS CH W?,K $4,496.85
ri A . 3: 3 ' ME 'DNOW
OW X4.49
JN 08 2004
RECEIPT DAT/
/ E f - < ! r BY DArRF fyAL FB-=• /J / / tNSPElR _,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
_ _
Combustion Air
Roof Deck
Fans
_
O.K. to Wrap
__.Exhaust
— —
F.A.U.
—
Framing
_
pressor
Insulation
'f<7
Vents
oe_
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
✓ 'Q
Drywall - Int. Lath
Final
Final
POOLS -SPAS
BLOCKWAL APPROVAL
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVA S
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
_
h
Encapsulation
Gas Piping
Gas Test
Appliances
_
Final
COMMENTS:
Final
J
Utility Notice (Gas)
ELECTRICAL APPROVAL
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
A IIA
Sub Panels
Exterior Receptacles
G.F.I.
If W
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
N U)
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W
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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
752884 B HIC 8/31/04
Date 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.
( ) 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 REPUBIC INDEMNIT' Policy No. 15671602
(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,
1 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
Warning: Failure to secure Workers' Compensation coverage 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 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
0312-241
DATE VALUATION LOT TRACT
$172,402.10 75 29323-1
JOB SITE
...
ADDRESS '9780 A 1ALFI DRIVE
APN
9-380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSAHOMES IL, INC.
PONDEROSA HOMES II INC
400 S. FARRELL DRIVE, STE, B103
400 S. FARRELL DR SUITE B 103
PALM SPRINGS CA 92264
PALM SPRINGS CA 92262
(703)187-710 CBL# 2346
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - LOT 75, PLAN 2AXR PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL SPA OR DRIVEWAY APPROACH
TRACT CONSTRUCTION 2,838.00 SF
PORCH/PATIO 387.00 SF
GARAGE/CARPORT 671.00 SF
ESTDAATED COST OF CONSTRUCTION
172,402.10
PERMIT FTE SUhD4"Y
CONSTRUCTION FEE 101-000-418-000 $895.00
PLAN CHECK FEE 101-000-439-318 $744.86
MECHANICAL FEE 101-000-421.000 $105.00
ELECTRICAL FEE 101-000-420-000 $146.25
PLUMBING FEE 101-000-419-000 $168.50
STRONO MOTION FEE - RESID 101-000-241-000 $17.24
GRADING FEE '101-000-423-000 $15.00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$4,496:85
LESS PRE -PAID FEES
$0.00
TOTAL PERAM FEES DUE NOW
$4,496.85
IIIIIIIIIIIIIIIIIIIIIIIII
51
IE
RECEIPT
DATE
BY
DATE FINALED
INSPECT09