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0305-121 (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 141C OV3 )/.2( ,Date rl Signature of Contractor \-��% , !J, /� , \` (�Nj OWNER -BUILDER DECLARATION v \t 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 REPUBIC WD9kMIT' 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 provlsi ns. Date: 1 I/t— I r Applicant— 1AA A�'`'-' Warning: Failure to secure Workers'�mpensation-couerage 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 inspection purposes. j Signature (Owner/Agent) ��'\ i/� L -Date BUILDING PERMIT PERMIT# Wli0&_Y21 DATE VALUATION LOT TRACT SX0q,244.70 46 ' 29323.1 JOB SITE ADDRESS (:. _790 pAIUMAY iESPL.,&I` ADE V5 Erf APN 649-980-023 OWNER CONTRACTOR / DESIGNER / EN (NEER PONDEROSA I.0)OS N, INC. PONDF.T OSA 14019M 7.15TC 6671 OWRt1NU D}2iW 400 S. F�.J., DR. KH—VE B 103 PLEAS.ANfON CA PALM SPR1N'C1S CA 92262 (703)187.710 (MLO 2346 USE OF PERMIT KN'OLE FARr9 Y DWELLB 0 SFD - LOT 46 PLAN 1AXR PLAN i' OFS NOTINCLUDE BLOCK W.A1.iA POOI1, SPA OR DIUVEWAY APPROACH, 75% REDUCTION TO PLAN CHECK FEE DUE TO MUL`TIPUZ ISSUANCE OF SAME PLAN °i 5'PS TRACT'' CONSTRUCTION 2,7n,00 SF PORiC"r1M ATIO 32,3.00 SP QARAGEfC.ARPORY 654,00 3F E1,712VIA.'I ED COST OF COff1.'I92TJMON' 16;5,244.70 CONSTRUCTION FEF 101-000.418.000 $870.50 PLAN CHECK FELE 101-000.439-.318 $190.69 MECELANICAL FES: 101-000-421-000 $92,00 XLECTWCAI FEE 1. ()1-OiDCI-42®-G00 $142.06. PLUMBING FLS 10.1-000-419-000 $167.26 S'i RONO.MO'TION FEE - RESID 101-000-241-000 QRADINO FRE 101-000-423-()00 VIM DEVELOPER IMPACT FIZ $2,40"i.Ot3 MM -TOTAL COMM13 MON fiND�l�gi��.-6,W' G+2� CCB pCTK'p �+�;�� f`1 IMS PRF,-PAEDF --B Q3r9`. $0.00 �� `1'AL ffy11�:?Wt ]+ r S DUE IVOW �,SS3!d.02 e O v 4 V -T RECEIPT DATE BY DA AL rj� L_ r� 1/. . i. /',�,1 i ,_ 10 .11 (SPECT INSPECTION RECORD OPERATION DATE INSPECTOR .6PERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs lei Underground Ducts Forms & Footings Ducts Slab GradeReturnAir ✓ Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap Framing i 421 .A.U. Compressordly 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 BLOCKWALL APPROVALS Final steel POOLS -SPAS 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 lectric Final Waste Lines / Heater Final Water Piping _ Plumbing Final Plumbing', up 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 0.0 Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors , Temp. Use of Power Final Oq Utility Notice (Perm) COMMENTS: r nereuy anirrn unuer penaty ur penury urar r am iwcnaau 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). 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.forwhich this permit is issued. (") I have and will maintain workers' compensafion 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 . RERUBIC: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,forwhich 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 complywith 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 thetcost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and att6rriey'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 whoserequest 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 L+vIL.vniW I L.1 11n1 I 030121 DATE VALUATION $165,244.70 LOT 46 TRACT 29323-1 JOB SITE ADDRESS 43-790 PARKWAY ESPLANADE WEST APN 609-380-023 OWNER CONTRACTOR / DESIGNER / EN (NEER PONDEROSA HOMES II, INC. PONDEROSA HOMES II INC 6671 OWENS DRIVE 400 9. FAF.RE ? • DR SUITE B 103 PLEASANTON CA PALM SPRINGS CA 92262 (703)187-710 CB1.# 2346 USE OF PERMIT SINGLE FAMILY DWELUNG SFD;- LOT. 46 : PLP,N:IAXR ,FLAN DOIP NOT INCLUDE BLOCK WALLS, . . POOL,"SPA�OR DRIVEWAY APPROACH. 75% REDUCTION TO PLAN CHECK FEE DUE TO MULTIPLE ISSUANCE OF SAFE PLAN TYPE TRACT CONSTRUCTION 2,728,00 SF PORCH/PATIO. 323.00 SF GARAOEICARPORT 634.00 SF ESTIMATED _COST OF CONSTRUCTION'. 165,244.70 PERMIT FEE SUMMARY CONSTRUCTION FEE -101-000-418-000 E87Qi50 PLAN;CHECK FEE 101-000-439=318 $180:69 - MECHANICAL _FEE 101'-000421-000 892; 00 ELECTRICAL FEE 101=000=420=000 SI4z"06 PLUMBING FEE 101-000-419-000 E167.25 STRONG MOTION. FEE • RESID 101-000-241-0.00 $16.52 GRADING, FEE. 101-000-423-000 813.00 DEVELOPER IMPACT FEE $3,405.00. SUB -TOTAL CONSTRUCTION AND PLAN CHECK $3,889.02 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $3,9.02 RECEIPT DATE BY DATE FINALED INSPECTOR