0307-236 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirmpnder penaltyAof 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
X2884 B1�IC � Mri1,12C
Signature of Contractor -
OWNER -BUILDER DEC AR TION
I hereby affirm under penalty of perjury that I am e empt 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
W RKER'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.
( A, I have and will maintain workers' compensation insurance, as required by
Se ion 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 114DU4'PIIT' Policy No. 196171601
(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
Codewl• hall.forthwith comply w`.�Qse provislo s.
Date: ZApplicant '
Warning. Fallure to secure Worke mpensa 5n coverage is unlawful and
shall subject an employer to criminii a Ities and-eMl•fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
r 'whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
'construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prgpertsy for inspection purposes.
Signature (Owner/Agent) l 1 A 0 Date ,
�---' 1d
BUILDING PERMIT PERMITff�`
M?-23tfw
DATE VALUATION �65e244.70 LOT 40 TRACT
S1.65,244.70 29323-1
JOB SITEAPN
ADDRESS 73 VAWMA Y FS.i�.EaANM'
,SQI VVO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
POFd EROSA Il0hCo+ S 11 INC
PO33DEROSA HOI�W Ii INC,
400 3, FAcZItML DR STJT-rE B 103
400 S, FAWkEi S.. DR SUITE B 103
PALM SPPIAIGS CA 92262
PAIM SPRINGS' NGS' C.P. 92262
(703)187-'710 C-Milf 2346
USE OF PERMIT
SFD -'LUT 40, PLAN IAXPL PERMIT DOES NOT INCLUDE BLOCK
EIVALLi1, P004 SPA O1. OSE WAY APPROACH 7S4/a REDUCTION TO PL kN
CHECK FEE DUE TO MULTIPLE ISSUANCE OF S.A.ME PLAN TYPE.
TRACT CON:3'1'.RLICTION Z720.40 SR
PORCHIPATIO 3as.a4 sr
0ARAGUCAILPORT 6SCOD 8P
lb"MdA;i'KV COS'f 011 C0175'Z'R'Ui,170N
V RbNr FRE
CONwT 1$'UCTlf3)1 PES? 101.000-$18.000 $970.50
PLAN CHECK FEE 101-000439-318 $180.69
rA:F; HANICAL FEE 101-000.421-000 5412.00
ZLECTRIC.A.L.FES 01- -420.000 $142.04
PLUMBING TSE 101.000-419.000 $167.25
STRONG MOTION FZZ - RESID 1011-000-241-000 $16.52
.
GRADING FEE 101.000-4423.000 SM60
I: EVEi.CTPER JIMPACT FEE $6,405.00+
auB-mrAL GU'PrT'�b'7'ItIJ'CTION AND PLAn Ci?1 xK
$3,889.02
i 1M3 PRE -PAD) .FTM
$0.00
•1.''otm .d 6umn ims D Lp Now
1"09102
RECEIPT
DATE
BY
D N
INS CTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OP RATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings l
Slab Grade i
Ducts
Return Air
Steel
_
Combustion Air
Roof Deck I
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor -
Insulation
Vents
Fireplace P.L. C
Grills
Fireplace:FO. i
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
1
Final
POOLS - PAS
Final i
-
BLOCKWALL APPRO L
steel
Set Backs i
Electric Bond
Footings I
Main Drain
Bond Beam 1
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final t
Gas Piping
PLUMBING PPROVALS
Gas Test
Electric Final
Waste Lines E
Heater Final
Water Piping ! �.
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans i
O.K for Finish Plaster
Sewer Lateral Z17
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances )
Final
COMMENTS:
;
Final _ is
.Utility Notice (Gas) ✓
ELECTRICAL APPR VALS
-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
1
Final
Utility Notice (Perm) 91i
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
r
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 o'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.
( ) I have and will maintain workers' compensation Insurance, as required by
Section 3700_ of tWi Labor Code, for the performance of the ' , ork'for' ich' is
permit is issued. My workers' compensation-,lnsurance cajrier.& policy no. are:
Carrier REPUBIC INDEMNIT' Policy No. �' 13671601
(Ttiis 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
workefs' 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 arnemployer 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 Labol' 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, indemnity
& 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
0307-236
DATE VALUATION $165,244.70 LOT 40 TRACT 29323-1
JOB SITE
80
ADDRESS 43-5PARKWAY ESPLANADE WEST
APN
609-380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSA HOMES II INC
PONDEROSA HOMES II INC
400 S. FARRELL DR SUITE B 103
400 S. FAPRELL •• DR SUITE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)187.710 CBL# 2346
USE OF PERMIT
SINGLEFA1GLY DWELd:NG
5FD • LOT 40, PLAN IAXR PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL, -,SPA OR DRIVEWAY APPROACH 75% REDUCTION TO PLAN
CHECK FEE DUE TO MULTIPLE ISSUANCE'OF'SAML PLAN TYPE
TRACT CONSTRUCTION Z-728.00 SF
PORCH/PATIO 323:00, SF ..
(iARA(3E1CARPORT . 654.00 -SF
ESTIIVIA= COST OF.CONSTRUCTION
163,244:70
PERMIT FEE- SU AdARY
` CONSTRUCTION FEE 101.006=418=000 8870.50
PLAN CHECK FEE . 101-000-439=318 $180.69
MECHANICAL FEE 101-000421:-000 592.00
ELECTRICAL FEE 101-000-420-000 $142.66
PLUMBING. FEE 101.000.419.000 S167:25
STRONO, MOTION FEE - RESID 101-000:241-000 $16:52
ORADINOTEE . 101'-000.423-000 $15,00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,889.02
LF93 PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$3, 9.02
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR