0307-231 (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
52130,, B .aw( 0$J314z(
Date f 5Signature of Contractor 6A ✓1�
OWNER -BUILDER DECKRA. ION
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 ownevof 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.
f) 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 REPURIC 1?3I EMNIT' Policy No. 15671601
(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
Code, -[,s a,�.f4ghvjA comply with.Lhose provisions.,
Warning:JFailure to secure Workers' Compensation. ov 4gd 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 prop ity for inspection purposes.
Signature (Owner/Agent)ate 9d t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT W-407-231TRACT
1z- $172,492.10 3S 29323.1
_;
JOB SITE
APN
ADDRESS �_.� PAi4 1IPAY'T iNADL 1 ft�i
609-3W-=
•WNER
CONTRACTOR / DESIGNER / ENGINEER
POID'ER03AHOWIS iI INC
PONDEROSA.HOMM II LWC
400 3, FAR7R.ELL DR S(.1T1i: B 103
400 3, FARRF1,L DR CLW, �.' 103
PPIM SPRI1403 CA 92262
PALM! S.PlRINGS CA. 92262
(703)187=7113 CI3i#i .Mi6
-
USE OF PERMIT
MHOLE FAk,/7 LY' DWELUN l
SYD • LOT 48, PLAN abXL -PERMIT DOES 'NOT I.NC1+UD9 BLOCK
WALL% POO1, SPPA. OR DRIVE WAY APPROACH. 75% R.It WCTION TO
PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT CONSTRUCTION 23,31,00 SP
PORCH/PATIO 3 7,OU SF
0ARU OFJCARPOR.T oS71.0ti SF
ES'I'MA'Y�.� C0 OF COtV 1CT't01�
%72,413.2.10
PERE ' M SSIiA&WARY
CONSTRUCTION M.P. 101.000.418.000 $895.04
PIAN CHFCK FEE 101.060-439-318 $136.2
1MFCHANICAL FMFE 101-000-421-000 $105.00
LLECTMI AL3FEE 101-000-420-000 $145.25
PLUIa41ING FRE 101.000419.900 $168,50
STR.ONO MOTION FEE -• RESID 101 -000 -?,41-000 $11 M
GRADR40 FEE 101.000-423.000
I)r%fELOPER IMPACT FEE
SLXFE•TOTAL CC:MTRU.CTION AND PLAN CHECK
$3,938.21
LESS PR&PAID Fn3
; 0.00
Al, 1'E321U-Yd.IR:1I:3 DYE NOW
!J
I
n r 2003
FINANCE
RECEIPT
DATE`S-�
BY
DAT NALE
O
INSP TOR
�. C! .2
11
.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
11, IJ
✓ ✓
Ducts
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
.gyp
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
✓
`
Final
Final ., -o
BLOCKWALL APPROV S
_
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
,p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
- /5.p
Encapsulation
Gas Piping
Gas Test
Appliances
i
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVAL
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:
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 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 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:
O I have and will maintain a certificate of corisent to self-insure>for workers'
compensatin, as provided for by Section 3700 of`the Labor Code, for the
performance'•of the work for,which this permit is issued.
( ) �11.have and will maintain workers' compensation insurance as required by
Section 3700 of the Labor Code,1or the.perfor`mance 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 be completed if the permit valuation; is for $100.00 or less).
ce
O I rtify'that in the_perforniance of the work for which this permit is issued,
I shaRnot employ any person in any manner so as to'become subject to the
workers' compensation laws of California, and agree that if 1 should become
subje' '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#
0307-231
DATE VALUATION $172,402.10 LOT 38 TRACT 29323.1
JOB SITE
ADDRESS 43-5PARKWAY ESPLANADE.WEST
65
APN
609-380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSA HOMES II INC
PONDEROSAHOMES Il INC
400 S. FAFtRE • DR SUITE B 103
400 3; FARRELL DR SUITE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)187-710 CBL# 2346
USE OF PERMIT
SINGLE FAMILY DVhZLIJNG
STD - LOT 38, PLAN 2bXL. PERMIT DOES NOT INCLUDE BLOCK
WALLS, P0014 SPA OR DRIVE WAY.APPROAC.H. 75"/o REDUCTION TO
PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT, CONSTRUCTION 2,838.00 SF
PORCH/PATIO 387.00 SF
GARAGE(CARPORT 671.00 SF
ESTIMATED COST OF CONSTRUCTION
172,402.10
PERNIIT FEE SUNIIVIARY
CONSTRUCTION FEE 101.000-418.000 $895.00
PLAN CHECK FEE 101=000-439-318 $186.22
MECHANICAL FEE 101-000-421-000 $105.00
ELECTRICAL FEE 101-000=420-000 $146.25
PLUMBING=FEE 101-000-419.000 $168.50
STRONG 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
$3,938.21
LESS PRE -PAID FEES
$0.00
TOTAL PERAM FEES DUE NOW
$3,938.21 .
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR