0307-228 (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
73LSR4 13 7E3Ti'- 0�/31i2C
. I
Date Si
tgnature of Contractor k AA A4
IV
OWNER -BUILDER DECLA6ATIN
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(q) 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 RIt:PUI.11C 114DE44 NIT' Policy No. 13671691
(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 shc1ll forthwith comply wit. th se provisions.
.
Date: L nADDlicant /r AIA A
Warning: Failure to secure Worker` C'!ppensat1cn1cov@rage 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#
0307-228
DATE VALUATION. $g ni 0 LOT [ TRACT 29323_1 32 p 1
f9J� iQ.t���,�LI .��d 4�J�W.7'8
JOB SITE---
ADDRESS c4.`�-�lS� [' iE�l�.bOrlC`5' :Si�.11A1V1a�T iI. Q,/
APN 6 .��1�a -023
OWNER
CONTRACTOR/DESIGNER/EN (NEER
POND OSA HOMIL9 R INC
POND OSA ROWS 17 INC
400 S. F'ARRELL TSR. SUMS B 103
400 3. FAR1:1'a , DR TRYTTE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)M-710 (MIX, 2346
USE OF PERMIT
7ME ]h Q1NM,Y DWELLING
SFID • LOT sty PLAN 21XL PI TT 0011;.5 NOT MCLUD3E FiLOCK
WALIA P004 SPA OR DRIVE WAY APPROACH, 750/a REDUCTION TO
PLAN CHECK FEi? DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT CONSTRUCTION 2,838.00 OF
PO3CHIPA't IO 397.00 Sir
f1AiAWCARPORT 671,00 8F
EMMXI'1a'}M COST OF CONSM C110H
172,402.10
CON'3TRUCTION FEE 101-000-418-000 $89;$.00
PLAN CHErK FEE 1611.-000-439-318 1$186.23
MECHANICAL FEE 101-000.421.000 SM00
EI. WTRICA.L FEE 101-000-420-000 $146.23
PLUMBING FEE 101-000-419-000 $168.90
'
STRO'NO MOT1014 FEE < R&SID 101-000441-000 $11,24
ORADING FEE 101-000-423-000 S15.60
DIEV >LOPER IMPACT ISE
SUB TOTAL OOldM'GJ'C'3TOM AM PLAN' CERC.K
$3,938.21
1------/ LEW PRE -PAM FM
$0.00
Is DUE NOW
9'.74;.21.
r
�A,,'� 0 51003
i'LA QU6NTA
RECEIPT
DATE
BY
D INALE 1 IN ECTOR
,/!�
r,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
'
v
Ducts
Return Air
Steel
Electric Bond
Combustion Air
Roof Deck
Main Drain
Exhaust Fans
O.K. to Wrap
Approval to Cover
.A.U.
Framing
/
Compressor
Insulation
_
Vents 110,
Fireplace P.L.
Underground Pibg. Test
Grills
Fireplace T.O.
Gas Piping
Fans 8 Controls
Party Wall Insulation
Gas Test -
Condensate Lines
Party Wall Firewall
Electric Final
Waste Lines
Exterior Lath
Heater Final
Water Piping
Drywall - Int. Lath
_
Plumbing Top Out
Final �
Final
'VA,6�1�_
POOLS - SPAS
BLOCKWALL
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
.p
Encapsulation
Gas Piping
Gas Test
4
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 02
ELECTRICAL
' APPROVA
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
i'
Final
JI
mow.
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 11 Lic. Class Exp. Date
752884 B EHC 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 ownerofthe 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-'1he following declarations:
O I have and will maintain a certificate of consent to self -insure for woekers'
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 REPUBIC INDEMNIT' Policy No. 15671601
(This section need not be completed if the permit valuation Is for $100.00 o_ r less).
O Icertify that in the performance of the work for which this periniVis 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: Applicanf
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 the1abor 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 applicator 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#
0307-228
DATE VALUATION $172,402.10 LOT 35 TRACT 29313-1
JOB SITE
ADDRESS 43-661 PARKWAY ESPLANADE WEST
APN 609-380-M
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
PONDEROSA HOMES H INC
PONDEROSA HOMES 11INC
400 S. FARRELL DR SUITE B 103
400 S. FARRE L DR SUITE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)187-710 CBL4 2346
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD -. LOT,35, PLAN 2BXL. PERMIT DOES NOT INCLUDE BLOCK
WALLS; POOIA;SPA OR DRIVE WAY APPROACH. 75% REDUCTION TO
PLAN'CHF,C. -FEE DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT CONSTRUCTION 1,839.00 SF
PORCH/PATIO. 38'L00 SF
GARAGE/CARPORT 671.00 SF
xsil v ATED COST OF CONSTRUC71ON
172,402.10
PERbUr FEE 9U3Aa1A3RY
CONSTRUCTION TEE 101-000.418.000 $895.00
PLAN CHECK FEE 101-000-439-318 $196.37
MECHANICAL FEE 101-000-421-000 $105.00
ELECTRICAL FEE 101=000-420-000 $146.35
PLUMBING FEE 101-000.419.000 $168.50
STRONG MOTION FEE - RESID 101-000-241-000 $1?.24
GRADING) FEE 101-000-423-000 $13.00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$3,938.21
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$3,938.21
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR