04-4146 (SFD)TWf °l 4 Q"
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760),777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQ -UX -5 44&+q -6-W1 777-7153
BUILDING PERMIT
Application Number
Property Address . . . .
APN:
Application description
Property Zoning . .
Application valuation
Owner
PONDEROSA HOMES II, LLC
400 S. FARRELL DRIVE, B103
PALM SPRINGS, CA 92264
LA QUINTA CA 92253
MA`l 4 2Q04 �I
04-00'004146 2 D!-' 5/13/04
79705 CORTE OIV -, QUINTA
609-580-008-
DWELLING - SINGLE FAMILY DETACHED
LOW DENSITY RESIDENTIAL
201360
Contractor
PONDEROSA HOMES II, INC.
6671 OWENS DRIVE
PLEASANTON CA 94588
(760) 318-7710
Qty Unit Charge Per
Extension
WCC: REPUBLIC
WC: 15671602
10/01/04
CSLB: 752884
08/31/04
CCC: B
--------------------------
Structure Information -------------------------
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type .. . .
. . .. DWELLG/LODGING/LONG <=10
Flood Zone . . . .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION
2001 CRC
# BEDROOMS
5.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG
502.00
PATIO -SQ FTG
500.00
NUMBER OF UNITS
1.00
FIRST FLOOR SQ FTG
3232.00
-------------------------------------7--------------=-----------------------
Permit . . . . . .
BUILDING PERMIT
Additional desc . .
Permit Fee
996.50 Plan Check Fee
647.73
Issue Date . . . .
Valuation'
201360
Qty Unit Charge
Per
Extension
BASE FEE
639.50
102.00 3.5000
THOU BLDG 100,001-500,000
357.00
----------------------------------------------------------------------------
Permit . . . . . .
MECHANICAL
Additional desc
Permit Fee . . . .
83.50 Plan Check Fee
20.88
Issue Date . . . .
Valuation
0
Qty Unit Charge Per
Extension
14
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: O 4 — 414( 1 Date: S= .21-04
Applicant:
Applicant's Mailing Address:
�0
Arglaitect or Engineer:
'Architect or Engineer's Address:
— N_7_.
Q�
ic. No.: 0-1 S� % A)ftV PafiT br&df
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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
Cyd and ss License ' n full force and effect. 0 �Lg AnA
z
icenseClass2, icenseNo. L (J"'�
ate c� nt..or
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
WORKERS' 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 Section 3700 of the Labor Code, for the performance of the work for which this permit is
ork rs' ompensation rce carrier and policy number are:
a1saran
merolicv Number
_ I certify that, in the performance of the work for which this permit is iss ed, I s call 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.
WARNING: FAILURE TO SECURE WORKERS' Ci51Ci1PENSATION CMERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 160 days will subject permit to cancellation.
I certify that I have read this application snd state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, a, n
ddf hereby authorize rep' entatives of this county to enter upon the above-mentioned property for inspection purposes.
Zte 1 ignature (Applicant or Agent):
Application Number . . . . . 04-0000414'6
Page 2
Date 5/13/04
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
2.00
9.0000
EA
MECH
FURNACE <=100K
18.00
2.00
9.0000
EA
MECH
B/C <=3HP/100K BTU
18.00
4.00
6.5000
EA
MECH
VENT FAN
26.00
1.00
.6.5000
EA
MECH
EXHAUST HOOD
6.50
----------------------------------------------------------------------------
Permit .
. . . . .
ELEC-NEW RESIDENTIAL
Additional
desc
Permit Fee
. . . .
138.16
Plan Check Fee
34.54
Issue Date
. . . .
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
3232.00
.0350
ELEC
NEW RES - 1 OR 2 FAMILY
113.12
502.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
10.04
---------------------------=-------
Permit
--
PLUMBING
----------------------=----------------
Additional
desc
Permit Fee
. . . .
.178.50
Plan Check Fee
44.63
Issue Date
. . . .
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
18.00
6.0000
EA
PLB
FIXTURE
108.00
1.00
15..0000
EA
PLB
BUILDING SEWER
15.00
1.00
7.5000
EA
PLB
WATER HEATER/VENT
7.50
1.00
3.0000
EA
PLB
WATER INST/ALT/REP
3.00
1.00
9.0000
EA
PLB
LAWN SPRINKLER SYSTEM
9.00
8.00
.7500.EA
PLB
GAS PIPE >=5
6.00
1.00
15.0000
EA
PLB
GAS METER
15.00
-----------------------------------------7-----------------------------------
Permit .
. . . . .
GRADING PERMIT
Additional
desc
Permit Fee
. . ..
15.00
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
----------------------------------------------------------------------------
Special Notes
and Comments
SFD - LOT
86. PLAN 3CXL(3).
PERMIT
DOES
0
Page 3
Application Number . . . . .
04-00004146 Date 5/13/04
-----------------------------------------------7----------------------------
Special Notes and
Comments
NOT INCLUDE BLOCK
WALL, POOL,
SPA OR
DRIVEWAY APPROACH.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
ART IN PUBLIC PLACES -RES
20.00
DIF COMMUNITY CENTERS -RES•
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
64.77
DIF FIRE PROTECTION -RES
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI) - RES
20.13
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
-----------------
Charged
----------
Paid Credited
------------------------------
Due
Permit Fee Total
1411.66
.00 .00
1411.66
Plan Check Total
747.78
.00 .00
747.78
Other Fee Total
2509.90
.00 .00
2509.90
Grand Total
4669.34.
.00 .00
4669.34