0307-233 (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
B 0J31f2C
,Signature of Contr7�—
OWNER-BUILDER DECL`ASATION 60
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). Y
( ) 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.
t�t) 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 RS!PUBIC INDFMNIT' Policy No. 151M651
(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
Warning: Failure to secure Workef ' CImpensathnn co er`atge is unlawful and
shall subject an employer to criminahpealties and civl 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.
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 p operty for inspection purposes.
Signature (Owner/Agent) Date i
BUILDING PERMIT PERMIT#
VO
=7-M
DATE VALUATION LOTTRACT
`� . G ' !� gi1 ,77� d1 43 29323.1
JOB SITE
ADDRESS t¢v;ar fk r�-1A+1KliYIA!! i�''iL'�i ��IP�T�4ii. �fJiS�y
APND.
OWNER
CONTRACTOR / DESIGNER / EN INEER
POA%DEROSA'I-IOMAS II DIC
PONDEROSA. HOMES T1: INC
400 3, FARRR'LL DR SMM B 103
400 3, FAMUML DR SUITE B 103
PALM, SPRINGS CA 42262
PALM SPRWG.1 CA 92262
(703)187.710 CBLN 2346
USE OF PERMIT
SMOIX F'AWJI Y DWaLT.I G
5 D - LOT 43, PLAN 3AXL P231111T DOES NOT INCLUDE SLOCK
WALIA,, POq" SPA OR DRIVEWAY APPROACH. 75% REDUCTION TO
PLAN CHECK FUZ DUE TO MULTIPLL+ MSU.FtiNCE OF SA.MZ PLAN TYPE
TRACT CONSTRLTTION 3,453.00 SF
PORCHIPA.TIO 300.00 SF
GARAGEJCA.RPORT 01.00 OF
ESI7iFl4YATED COST OF CONS IMUC1701 T
1.851775-W
PERM ' Ti`s 9UAMeRY
CONSTRUCTION FEE 101-000.418.000 $940.30
PLAN CHECK .FEE 101-000-439--318 $ 294.130
MECHANICAL nE 101.000.421-000 $90,50
ELECTTUCAL FFE 101-000-420-000 $153.98
PL,L MBINO no 101-400.419.000 5174.S0
STRONG NOTION FEE ., RESID '101-000-241-000 $18.514
O ADINO FEE 101-000.423-000 S 15, 00
DLVL+WPER IMPACT FEE $3,405.00
ITB , CN3�Ts C`171ox AND 7>LA;1?T CHECK
TZ4,000.86
1.03 BRE-PAJD PEGS
$0.00
TOTAL PYO14 T FEFES DUE NOW
-.5 2003
ffi�4 .iff
RECEIPT
DATE
BY
DA I
I PECTO
IZ
INSPECTION RECORD
Or OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
✓
Ducts
Return Air
Steel
Combustion Air
Roof Deck-
Exhaust Fans
O.K to Wrap
F.A.U. /
Framing
j'
Compressor /
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
oe—
/Final
or
Final An
BLOCKWALL APPROVALS
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
Heater Final
Water Piping
v
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
-
Final -
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
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 A -7i
Final
Utility Notice (Perm) •
COMMENTS:
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter -9 k1commencing 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).
O I am exempt under Section B&P.C. for this reason
Date •Signature of Owner
I
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 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 thework for•which this
'permlf is issued. My`workers.comsancearrer& ppolicy'no. are:
Carrier REPUBIC ,INDEMNIT' Policy No. 15671601'
(This section need not be completed if the permit valuation is for $10.0.00 or less).
O 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 Ishould-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 subjeci,anemployer to criminal penalties and civil fines up toll 00,000, 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 -233 -
DATE VALUATION 5185,775.50 LOT 43 TRACT 29323.1
JOB SITE
ADDRESS 43-676 PARKWAY ESPLANADE WEST
APN 609-380-023
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PONDEROSAHOMES II INC
PONDEROSA HOMES II INC
400 S. FARRELL DR M= B 103
400 S, FARRE L DR SUTTE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)187-710 CBL# 2346
USE OF PERMIT
SINGLE FAMILY DWELLING
SFD - LOT 43, PLAN 3AXL. PERMIT DOES NOT INCLUDE BLOCK . .
WALLS, POOL, SPA OR DRIVE WAY APPROACH. 75% REDUCTION TO
'PLAN CHECK FEE DUE TO 4ULTIPLE`ISSUANCE'OF SAME PLAN TYPE
TRACT CONSTRUCTION 3,033OO.SF
PORCH/PATIO' 100.00 SF
GARAGE/CARPORT 681.00 SF
��ESTRKA=DD OST OF CONSTRUCTION
185,775.50
PERiVi>•I`FEE SUMMARY
CONSTRUCTION FEE 101=000-418-000 5940.50
PLAN.CHECK FEE 101-000=439-318 $194.80
MECHANICAL FEE 101-000=421-000 $98.50
ELECTRICAL FEE 101=000-420-000 $153.98
PLUMBIN.0 FEE 101.000-419.000 $174.50
STRONG LOTION FEE - RESID 101-000-241-000 $18:58
ORADING FEE 101=000-423.000 $15.00
DEVELOPER IMPACT FEE $2,405.00
SUB -TOTAL, CONSTRUCTION AND PLAN CHECK
$4,000.86
LESS PRE -PAID FEES
$0.00
TOTAL PERINIIT FEES DUE NOW
$4,000.86
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR