0307-227 (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
752:1 13 EUC 08131/2(
Date Signature of Contractor �``to�� ",
OWNER -BUILDER DEC L!/�RATION` )
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
J Y
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.
( f) 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 Rf NLrB,C 1)31)IVMNn,, Policy No. I3f371663
(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 s all f rthlth comply wit those pro sions� /fie
Date: r i /1 Applicant / ��,
Warning: Failure to secure Worker(co pensati nv re age is unlawful and
shall subject an employer to criminal'pen Ities 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 forinspectionpurposes.
`, "
�,Signature (Owner/Agent)M04te
BUILDING PERMIT PERMIT#
OS0 7-22?
DATE VALUATION LOT TRACT
>&Z0:5,77:'n�0 34 2932114-1*
JOB SITE--
ADDRESS 7t;i�2C��YAY 1�.S1'P..FLl�ir�Y: �V�v —
APN �tbt� Rypt1 tNf«A
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PC13 F' ROS.A HOS 11 JNC
PO331M.05A II(MMES It R4C
400 S. F ARREIX DR 81M.2 D 103
400 M P,,A%, l ELL I>R SLMTI-E B 103
PAL14 LPRINGS CA. 92262
PA12A &M. as CA 92262
(703)187.X0 CBL4 2346
USE OF PERMIT
WHO) R E.AMff-Y DWZJ IWG
5FD - Lt:)T 34, PLAN 3AXR. PERMIT DOES moo rmcLunir, .BtaOCK
WALLS, P604 SPA OR DRIVE WAY APPROACH
A
TRACT CONSTRUCTION x,093.00 SF
POKCHJPAno 360.016 SF
OARA01K°A11.PORi 481.00 3E
:4Ir MA?AnM COST, OF COPMTitr°1` OX
185,'775.50
g'FItJaM .FEE SUla11I19ARY
C01" S17RUCTIOIN ME 101-000-418-000 MOM
PLA43' CHECK PER 101-0.00.439-310 M.20
MWRAAlICAL FEE 101.000.421-000 $93.50
ETIECTRICAL PER 101-000-420-0.00 $153.98
PL11MSINO IEEE 101.000.419-000 $174.50
STRONG MOTION FEE - RESID 101-000-241-000 $18.58
GRADING PC, 1; 101.000-.423.000 215.00
IMPVLPLOPER IMPACT FUE $4403.00
SG S `fOTiAL CONWI RUC:17OR AND PY-W r—'I=
$4,585.26
LE35 PRE -PAID FFM
$0.00
" '
AUG
0 5 2003
CP�t
RECEIPT
DATE
BY
TE FIN ED
I PECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings:
Ducts s
-Slab Grade
Return Air
Steel
—
Combustion Air
Roof Deck
OX to Wrap
Framing
i
s
Exhaust Fans
F.A.U.
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
Final
Final
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
9,0.
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover _
Sewer Connection,
'L-Z."L03
C
Encapsulation
Gas Piping
OP
Gas Test
✓
Appliances
-
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVAL
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
Final
Utility Notice (Perm) (,'
COMMENTS:
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
1
I hereby affirm under penalty sof 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 the°work for which this
permit is issuedr My workers' compensation insurance carrier, &- no. are:
Carrier REPUBIC'INDEMNIT' Policy: No'- 15671601
(This section need not be completed if the permit valuation is for $100.00 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 *1 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: ADDlicant
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.l 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#
0307-227
DATE VALUATION $185,775.50 LOT 34 TRACT 29323-1
JOB SITE
ADDRESS 43-693 PARKWAY ESPLANADE WEST
APN
609-380-023
OWNER
CONTRACTOR / DESIGNER / EN INEER
PONDEROSA HOMES H INC
PONDEROSA HOMES II INC
400 S. FAFtI. E T • DR SUITE B 103
400 S. FARRELL DR SUITE B 103
PALM SPRINGS CA 92262
PALM SPRINGS CA 92262
(703)187-710 CBL4 2346
USE OF PERMIT
SINGLE FAMILY DWELZAIG
SFD • LOT 34, PLAN 3AXR PERMIT DOES NOT INCLUDE BLOCK
WALLS, POOL, SPA OR DRIVE WAY APPROACH
TRACT CONSTRUCTION 3,05100 SF
PORCHIPATIO", 500.00 SF
GARAQEICARPORT 681,00 SF
XST' "IXD COST OF CONSTRUCTION
185,775.50
PERAW F may:
CONSTRUCTIONIEE 101-000-418-000 $940.50
PLAN CHECK. FEE 101-000-439-318 $779.20
MECHANICAL FEE 101.000-421-000 $98,50
ELECTRICAL. FEE 101-000-420-000 $153.98
PLUMBING FEE 101-000-419-000 $174.50
STRONQ MOTION FEE - RESID 101-000-241-000 $18.58
'
GRADING FEE 101.000-423-000 $15.00
DEVELOPER IMPACT FEE $1,405.00
SUB -TOTAL CONSTRUCTION AND PLAN C =
$4,585:26
LESS PRE -PAID FEES
$0,00
TOTAL PERMIT FEES DUE NOW
$4,585.26
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR