0307-229 (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
'�
Blf
08l`.i 1 P'YC
Date f I Signature of Coor
OWNER -BUILDER DECIRATIOP4Q
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 fot 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 issued. My workers' compensation insurance carrier & policy no. are:
Carrier RDURIC lNDEMNIT. Policy No. 1567JO01
(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
Coded -shall fort`hwjt� comply with those provisions.
Date"Vi AkA
Warning: Failure to secure Work rs' ompens tion overage is unlawful and
shall subject an employer to crimin I -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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
J_
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 f rinspection purposes. r
Signature (Owner/Agent) Date 16�
BUILDING PERMIT'' PERMIT#
Q}3Q7-22�J
DATE VALUATION LOT TRACT
c a; S185,77&!A) 36 251323.1
JOB SITE _ _ /
ADDRESS .- 1?AA2IiVVA.� .1i.�.15I.u9x�AI)&: wel' �I 11
APN
669-38041123
OWNER CONTRACTOR / DESIGNER / ENGINEER
PONDEROSA 1101AES II INC PO.Al1'WROSA HOhM U INC
400 S. FARRELLp DR. BUY -FE B 103 400 S. PARRY U, DR SIl"1•17, B 103
PALM SIPMOS CA 92262 PAIM SPRMOS C°,.cA, 92262
(703)187.710 CBIA, 2346
USE OF PERMIT
MX1131y"FAW..My D1hd1rL ITiC
SFD - LOT 36fFrI.AN 3CXR, PERMIT DOES NOT INCf.' DE i3L:.C1Cr,"K
WALLS, POOL4 SPA OR DRIVE WAY .APPROACH. 75% REDUCTION TO
PLAN CHECK FTSE DO F, TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
T C1 CONSTRUCTION 053.00 SF ,
PORCHIPA ICI 500.00 SN
OARAO AItPORT 031.00 SF
R91MAIWD COST OF COXMUCOnOX
1I 775 AVJ
CONSTRUCTION FRE 101-7105)-416-000 S94C50
PLAN CRECK FEE 101-000-4-39-318 V94.90
MECHANICAL FEE 101-000-421-000 M J0
ELECTRICAL FU' 101-000420-000
PLUMBIE O FEE 101.000.419.000 E174.110
S'i'ft®NCR MOTION IEE - RESID 101-000-7.4.1-000 $18.33
10 A DING iFER 101-000-423-000 915109
DEVELOPER IMPACT PESa $�,443.Of3
SUB-TOIAL CONTMITC ON. AND PLAN .CK
$4,000.86
LE38 PRF, PA.t1) TEES
$0.00
FFEES .� VE L'I VJ Yi
REM. XX
Y
•✓7`000,86
lulG 05 2003
CITY OF LA OUINTA
FINANCE DEPT.
RECEIPT DATE
BY
DAT NA
f4q INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPf RATION
DATE
INSPECTOR
BUILDING
APPROVALS,-
MECHANICAL APPROVALS
Set Backs
n.
Und€rground Ducts
Forms & Footings
r
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
s
F.A.U.
Framing
✓
Compressor
Insulation
Fireplace P.L.
Z2cVents
_
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
r
Drywall - Int. Lath
Final
Final
POOL$ - PA y��
BLOCKWALL
A PR AL
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
— U
Heater Final
Water Piping
YZ2 r.4
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection'
p — 3
Encapsulation
Gas Piping
Gas Test
/
Appliances
`
Final
COMMENTS:
007
Final .
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles J
G.F.I.
Smoke Detectors 100,
Temp. Use of Power 00)
1,110001,
0400,
Final
Utility Notice (Perm) ✓
L.—
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 pro r
ty,'am exclusively contracting 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 one of thefollowing declarations:
( )' I have'and will maintain a`certificate oUc.onsent 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:
Cartier REPUBIC INDEMNIT' 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, 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-undeOr 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#
0307-229
DATE VALUATION $185,775.50 LOT 36 TRACT 29323-1
JOB SITEAPN
ADDRESS 43-629 PARKWAY ESPLANADE WEST
609-380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSA HOMES H INC
PONDEROSA HOMES II INC
400 & FARR L • DR 3UTTE B 103
400 S. FARRE T • DR SUITE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)187-710 CBI:# 2346
USE OF PERMIT
SINGLE FA ZLY DWELLING
SFU • LOT 36, PLAN"300R' PERMIT DOES'NOT INCLUDE BLOCK.
WALLS, POOL, PPA OR DRIVE WAY APPROACH. 73%o REDUCTION. TO
PLAN CHECK FEE DUE TO MULTIPLE I§§0XNCE`OF SAIME'PLAN TYPE
TRACT CONSTRUCTION 3,03100 SF
PORCH/PATIO:: 500:00 SF
GARAGE/CARPORT 681:00 SF
ESTIMATED COST OF CONSTRUCTION
185,775.50. .
FlZbflT FEE SiJBDdARY.
CONSTRUCTION FEE 101-000-4:18-000 $940,50
PLAN CHECK FEE 101-000-439-318 $194.80
MECHANICAL FEE 101-000.421"-000 598,50
ELECTRICAL FEE 101-000-420-000 $153:98
PLUMBINQFEE 101-000=419-000.. $174.50
.STRONO MOTION FEE • RESID 101-000-241'-000
GRADING FEE 101.000-423-000 $15:00
DEVELOPER IMPACT FEE $x,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CH=
$4,000:86
IMS PRE -PAID FEES
$0.00
TOTAL PEMW FEES DUE NOW
$4,000.86
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR