0307-234 (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
'752 B 0 I.f.(
Dat Signature Signature of Contractor l "►
OWNER -BUILDER DE0.AR TION
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.
(\) 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 RgpU9IC INDEY Xpr Policy No. - 13671601
(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.sh II fort `with comply ode provisions.
Date: V� plicant d
Warning. Failur to secure Worker Co pensati tn��,�AAagevis unlawful and
shall subject an employer to criminal peva ies 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 pr erty for inspection purposes.
"_15,__ Signature (Owner/Agent) % E'l Date
BUILDING PERMIT PERMIT#
0�7-2;9�d
DATE VALUATION $112,402 -.Iii LOT 42 TRACT 293231
JOB SITE
ADDRESS C'' 6,14 PAI I WA, �+ r1~'1aAiV,ff � �b6-0eiT�
APN 6W.�00-023
OWNER
-CONTRACTOR / DESIGNER / EN (NEER
POt1DF. ROSA H01YE.S 31 C .
P0NDE RUSA HOas If INC
400 S. FARRELL DR SUTIF B 103
400 23, FARRM.,L 31i SUITE B 103
PALM SPRINGS CA 92262
PALM S.P GS CA 92262
C704)187.710 CBL4 234x5
USE OF PERMIT
SINGLE FA1aSI7LY DV►�7 -WG
SPD - LOT 42, PL U4 2CIM PEI fAIT 110,n NOT INCI.,UDF, (BLOCK
WALL, P0016 EPA OR I� Ir WAY APPROACH. 75% `�DIJ10 ON TO
PLA14 CHECK f�i£E D139 TO MULTIPLE aSSUANCZ OF SAM PLAN `HYPE
TRACT CONSTRUCTION �f§33,01 9F
PORCHIPATIO 397.00 3F
OARAIJEWARPOR'1' 671.00 SF
Xii M ATM COW OF i'ONS UCnON 172,402.3.0
iP1E:RI�LiiF FEE I` hE.11 ARY
CONSTRUCTION FEE 101-000-418-000 $393.00
PLAN CHECK FEE 801-000-439-318 $186.x22
MECHANICAL FEE 101.000-421.000 $143.01
EUCTRICAL FES 101-000-420-000 8a�s.as
PLU1vi1;3INO ltt Z 101.0006419.000 3166.90
STRONG MOTION FES • R'ESID 101-000-241-000 $17.34
OttADING FEE 101.000.42.4-000 13ao
DEVELOPER IMPACT i+F.rr $2403:00
SUB. -TOTAL CO,Aia11TiUC LION AND PI 41 � $3,9.38.21
LESS PRE -PAID : S $0,00
i
- `G'OT- . P'K. f ! El S DUE NOW ,5;38. 3,
I n,P ,,
9i :ir1
1*7
RECEIPT
DATE
BY F L68/1
IN PECT
(JZbof
UYV V `" I .4..._0_1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 1
Underground Ducts
Forms & Footings I zy
Ducts
Return Air
Slab Grade
Steel }
- ombustion Air If
Roof Deck - ; -/Exhaust
Fans
OX to WrapF.A.U.loll
Framing I _
Compressor
Insulation i
FireplaceP.L. 01Grills
Vents 00
Fireplace T.O. 1
Fans $ Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 1
Drywall - Int. Lath )
t
I
iA
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 1
Gas Piping
PLUMBING AP OVALS
Gas Test
Electric Final
Waste Lines _
Heater Final
Water Piping !• /
Plumbing Final
_
Plumbing Top Out
Equipment Enclosure
Shower Pans 1
O.K. for Finish Plaster
Sewer Lateral I
Pool Cover
Sewer Connection. - -
Encapsulation
Gas Piping r
Gas Test
Appliances )
Final
COMMENTS:
_
i'
Final.
Utility Notice (Gas)
ELECTRICAL 'APPROVALS
Temp, Power Pole
Underground Conduit
Rough Wiring 1 i
Low Voltage Wiring
Fixtures
Main Service
.,Sub Panels
Exterior Receptacles —
G.F.I. I
Smoke Detectors 1
Temp. Use of Power
Final 1 -
-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 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 consent to self -insure for workers'
compensation, as provided .for. by Section 37.00 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 REPUBIC INDEMNIT' Policy No. 13671601 .
(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
workerscompensation 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#
0307-234
DATE VALUATION $172,402.10 LOT 42 TRACT 29323.1
JOB SITE
ADDRESS 43-644 PARKWAY ESPLANADE WEST
AP" 609-380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSAHOMES II INC
PONDEROSAHOMES R INC
400 S. FARRELL DR SUITE B 103
400 S. FARRELL DR SUITE B 103
PALM SPRINGS CA 92262.
PALM SPRINGS CA 92262
(703)187-710 CBL# 2346
USE OF PERMIT
SINGLE FAMILY DWELL. NG
SID - LOT 42, PLAN 2CXR. PERMIT i70E8 NOT INCLUDE BLOCK
WALLS, POOL, SPA OR DRIVE WAY APPROACW75%o REDUCTION TO
PLAN CHECK FEE -DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT CONSTRUCTION 1,838.00.SF
PORCHIPATIO 387.00 SF
OARAGElCARPORT 671.00 SF
ESTIMATED COST OF CONSTRUCnON
172,402.10
PERma FEE SIIMMARY .
CONSTRUCTION FEE 101-000-418-000 $893.0
PLAN CHECK FEE 101-000-439=318 8186.22
MECHANICAL FEE 101=000-421=000 $103.00
ELECTRICAL FEE 10.1-000-420-000 $146.25
PLUMBING FEE 101=000.419.000 $168.30
STRONO MOTION FEE - RESID 101-000-241-000 $17.24
ORADING FEE.. 101=000-423-000 $13100
DEVELOPER IMPACT FEE $2,405.00
STM TOTAL CONSTRUCTION AND PLAN Cl=
$3,938.21
LESS PRE -PAM -FEES
$0.00
TOTAL PERAM FEES DUE NOW
$3,938.21
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR .