0307-237 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under,.penaltyQf 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
7 `21 6._ � E 03/� 3IiIt
Date'ignature of Contractor
OWNER -BUILDER DECJ�RA�ION
`6(��
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.
(ai) 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 REPUBI .` INOEMNIT' Policy No. 19691601
(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
CogIp—, kS 41l-fO4hwjtf3 complyvvith:.t .0Se' pfgvi,iow �A .c A_
Warning: Failure to secure Worker ' Cc pensation Eo,Yarage is unlawful and
shall subject an employer to criminal p R Ities 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 herby authorize representatives of this City to enter upon
the above-mentioned p opelly—for inspection purposes.
'signature (Owner/Agent) + AAJ' b Date �✓
PERMIT#
BUILDING PERMIT
r1' .
t130'7-23 ?
DATE VALUATION = LOT TRACT
:, $3.8°1,775-5U 29323.1
.39
JOB SITE
APN
ADDRESS 3-548 PA.P... W IIY ENT1.nat1 NADE ' of
QSv, i •�5 �-�
OWNER
CONTRACTOR / DESIGNER / EN (NEER ,
$C3NDE-R09!• ROYo W111 INC.
POWDEROSA H AhES TL. DIC '
400 S, FARE EIL TSR SMTE 13 103
400 S,1?ARRM T_, DR S07E' B 11031
PALM SPRING -3 CA. 92262
PAT.ivi SPRINGS CA 92262
(703)187.710 C.BUt 2.34.6
USE OF PERMIT
SWEH-k FAWL Y DWUNG
SFI) - LOT 39; PLAN 3C. -.L. 'PMMIT VOES NOT 11dC1 ucm BLOCK
WALLS, POOL, SPA OR DRIVE WAY APPROACH. 75% PiT:,DUC`CION TO
PLAN CHECK FEE DQJ.VM tVUL,TIPL E ISSUANCE OF SAla F eP'ta1N TYPE
TRACT C:OA STRUC;TION :!,053.00 a1;
POir .CHIPATIO 500.00 SP
GARAGE/CARPORT 63140 SF
' AfED COST OF CONGMUCT`i N
Y, Imo' FEE SURl,Ct URY
CONSTRUCTION FEE 101.000-410.000 S91O."
PL•IiN CHECK FEE 101-000.439-318
•000-421.000 49x.30
MECHANICAL FILE 16-000-421-000
ELECTRICAL FEE 101-000-420-000 $153.911
PLUMBINO ME 101.000.419.000 $174,30
STRONG MOTION FE. .E. RIrSID 101-000-341-000 $18:38 ,
ORA103NO FEE 101-004.423.000. $3S.J0
IDEVEIDPL+R IMPAC`!' FES
e 9U.13-T'fl1M, COM-RUCTIOIT A>?T& PI A.N CIM .
$4,000.86
LESS PRE.PA110 FEES
Ti+Jm
RECEIPT
DATE
BV- -y
ID2 rl
IN fECTOR
7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
✓
Ducts '
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
Framing
✓
•
F.A.U.
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 •
oo
lool—
Final
Final
_
POOLS - SPAS
BLOCKWALL
APPROVALS
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
✓
Encapsulation
Gas Test
i
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
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
Ii
Final
Utility Notice (Perm)
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 HRC 08/31/2(
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:7 with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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 oneof the following declarations:
O I have and will; maintain a certificate'of�consent-torself-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; forthe performance'of the work for which this
permit is issued. My workers' compensation- insurance carrier ,& policy no: are:
Carrier REPUBIC INDEMNIT'... - POlicy No. :15671601
(This section need not•b'e 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: 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#
0307-237
-1
DATE VALUATION $185,7,75.50 LOT 39 TRACT 29323JOB
SITE
ADDRESS 43-548 PARKWAY ESPLANADE WEST
APN 609-380-M
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSA HOMES 11 INC
PONDEROSA HOMES II INC
400 S. FARRE 1 • DR SUITE B 103
400 S. FARRELL DR S= B 103
PALM SPRINGS CA 92262
PAI Iv SPRINGS CA 92262
(703)187.710 CBL4 2346
USE OF PERMIT
SINGLE FA14 LY DVIELS WO
SFD - LOT 39, PLAN 3CXL. PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOIJPA OR DRIVE WAY APPROACH. 75% REDUCTION TO
PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT. CONSTRUCTION 3,033.00 SF,
PORCH/PATIO 500.00 SF
GARAGE/CARPORT 681.00 SF
ESTIMATED COST OF CONSMUCTION '
185,775.50
PERma FEE SUNIIViARY
CONSTRUCTION FEE 101 -000-418-600 $940.50
PLAN CHECK FEE 101-000-439=318 $194.80
MECHANICAL FEE 101-000.421.000 $98.50
ELECTRICAL FaEE 101-000-420-000 $113.98
PLUMBING FEE 101:-000-419-000 $174.50
STRONO MOTION FEE - RESID 101-000-241-000 $18.58
GRADING FEE 101-000-423.000 $15.00
DEVELOPER IMPACT FEE $1,405.00
SUB -TOTAL CONSTRUCTION AND PLAN Ck=
$4,000.86
IMS PRE -PAID FEES
$0.00
TOTAL PERMLT FEES DUE NOW
$4,000.86
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR