0305-117 (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
752,884 0813I/V
Datet U Signature of Contractor ~ \
OWNER -BUILDER DEQLA\RATION1•
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 REPUDIC INDRAIN'I f • Policy No. 14671601
(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 provisions.
Dater�^ S l u Applicant ---�-=` 1`e1-% r, U� y .W� . �.•
Warning: Faila�e to secure WorkEv' C'ompensali"n erage 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 I
BUILDING PERMIT PERMIT#
iO 21; 7
DATE VALUATION LOT TRACT
$17242.10 30 29323-1
JOB SITE Y
ADDRESS 43•-82-% Pti9RKWAY LN,P MIADE Wr,..Vr
APN
380-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSARONM 11, LNC.
POid13.EROSA � OWM LI INC
6671 OvIaM DR1VFI
400 S, FARMX. M ; urm. ]3 103
PLEASANTON CR.
I AL RII S.PRINGS CA 92262
(703)187.710 CB1,4 2.346
USE OF PERMIT
SYD - LOT 50 PLAN 2BXF., f L.A bf DOES NOT INCLUDE E SLOC.IC
WAL"I POOL, 3PA OR DRIVEWAY APPROACH, 75% RODU::TION TO PLAN
CHECK IEE DUE TO MULTIPLE ISSUA14CE OF ;AME PLAN TYPE
TRACT CONSTRUCTION TION a,83 oo so
PORCWPATIO • 387.00 SP
G ARAC WCARPORT 671.00 SF
EUIM"IMD CO&'T OV CO.NSI' TC11Ot
3 4:t,4dl .gda
]?EPJVfn' F sSUA9".RY
CO ErrRUCT ION FEE 101.000.418.000 fR9S.0A
PLAN C:HItCK YES 101-000-439-318 $186,28
MECHANICAL FEE 101.000-421.000 $103.00
XLECTIUCAL RE 101-000-4-20-000 $146.25
PLUMBING FEE 101.0004419.000 5168.50
ST RON1O MOTION FEF, - RESID 101-000-2,41--000 $17.24
OR DING FEE 101.000.423-000 $15.40
DLV V0,0PER IN1LP.A. T IYEi $sl,4Q;5.OfD
SLIB TOTAL CONS UCnOW AND PLAY CBEZY,
$3,938.21
LXSS -L AID FLMS
$0,00
P!Ji�'1 I'FL S DUE 10OW
onca+
k1
.RECEIPT DATE BY DAT F LE INS
CTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel
Combustion Air l000
Roof Deck
Exhaust Fans
O.K. to Wrap
_J
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
?
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final IPOOLS
BLOCKWALL APP OVALS
-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 APPROVAL,
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
0
Encapsulation'
Gas Piping
Gas Test
Appliances
Final
Final )m LJ1YA
Utility Notice (Gas)
ELECTRICA 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:
I §.
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 111C 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).
( •):� as,owner•oVthe: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
l.. hereby affirm under penalty of perjury,. of the following ,declarations:
O I have and.wijl maintairi`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. ”
( .) b have.and will ,maintain workers compensation :insurance,"as,required by
,.,.. b.
Section; 3700 of the Labor Code, for the"'.pe, .' ' nce of�the work for which?chi's
,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 or less).
O I certify that in the performance.of the work for which:this permit is°issue:
I shall not employ any person in any manner so as to become subject to the
Workers' compensation Iaws.of California, and, agree that if1 should become
.:subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall,forthwith comply with those:provisions.
Date:Applicant t
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subiect.an employer°to criminal penalties -'and civil fines up to $100;000. in
atldition tothe cost of'compensatiori: amages as provided for.in Section 3706
of the LaborCode,'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 madeA 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#
030.5-117
DATE VALUATION $172,402.10 LOT 30 TRACT 29323.1
JOB SITE
ADDRESS 43-821 PARKWAY ESPLANADE WEST
APN 609-383
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PONDEROSA HOMES IL INC.
PONDEROSA HOMES II INC
6671 OWENS DRIVE
400 S, FARRELL DR SUITE B 103
PLEA CA
PALM SPRINGS CA 92262
(703)187.710 CB1.# 2346
USE OF PERMIT
SINGLE FAMILY DWEILUNG,
SFD - LOT 30 .PLAN 2BXR PLANVOES NOT INCLUDE, BLOCK'
WALLA TOOL, SPA OR DRIVEWAY APPROACH. 75%.REDUCTION TO PLAN
CHECK FEE DUE TQ,,MULTIPLE ISSUANCE OF SAME PLAN TYPE
TRACT ,CONSTRUCTION Z938.00 SF'
a PORCH/PATIO 387:00 SF
OARAGE/CARPORT 671:00, SF
ESTIlVIATED COST OF CONSTRUCTTON
172,402.10
PERIVIlT FEE SUMMARY .
CONSTRUCTION. FEE" 101.000.=418-000 5893:00
"PLAN
CHECK FEE 1.01-000-439 318. 5186:232
MECHANICAL FEE 101 0001,421-000 8103:00
ELECTRICAL FEE 101-000-4201- 000 S146.15
PI UMBINOYEE 101 000-4.19-000 1168 So'.
STR ONO MOTION FEE - RESID 1017-000-1241 x000- $2T.24
, RADING,,FEE 101.000-423.000 SIS.:00
DEVELOPER, IMPACT FEE $2,405.00
SUB=TOTAL CONSTRUCTION AND PLAN CHECK
$3,938.21
LESS PRE -PAID FEES
$0.00
TOTAL PERMrr FEES DUE NOW
$393811
RECEIPT
DATE
BY
DATE FINALED INSPECTOR