9512-0111 (PATIO)79115 Arbola Circle
cn LICENSED CONTRACTOR DECLARATION ALCM BUILDING PERMIT PERMIT
5X2-311
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with DATE L P VALUATION W.4JJI. C LOT TRACT
r W Section 7000) of Division 3 of the Business and Professionals Code, and my
O =) co JOB SITE ADDRESS APN
n O to License'is in full force and effect. 4#38234 B - 12/3/95 79.115 ARBOI A CIRCLL
LLJensa# Lic.Class cp.D
t` r` ate Z E3-tet Signatureof Contractor OWNER CONTRACTOR
a, Z ROGER SNELLENBERGER&ASS
cro o OWNER-BUILDER DECLARATION ROGER SNELLENBERGER&ASS 41865 BOARDWALK 0#212
J w 1 hereby affirm that I am exempt from the Contractor's License Law for the 41865 BOARDWALK#212 PALIVI DESERT CA 92211
CL following reason: PALM DESERT CA 92211 (619)777-7766 CB[,# 1.858
Z t-( ) I, as owner of the property, or-my employees with wages as their sole (6)t )777-7766 DESIGNERiENGINEER
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 USE OF PERMIT!1 1
contractors to construct the project(Sec.7044,Business&Professionals Code).
( ) I am exempt under Section B&P.C.for this reason OPEN LA1110E VINVIO COVI•.;tt
Date Signature of Owner
(V
rn WORKER'S COMPENSATION DECLARATION FEE DESCRIPTION FEES
d Q I hereby affirm under penalty of perjury one of the following declarations: PORL'"IWA.VO 258.00 Sh
C) Z ( ) I have and will maintain a certificate of consent to self-insure for workers'
HO compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL. performance of the work for which this permit is issued.
OJ J ( ) I have and will maintain workers'compensation insurance,as required by
m Q U Section 3700 of the Labor Code,for the performance of the work for which this
O U permit is issued. My workers'compensation insurance carrier&policy no.are:
CL LO H Carrier S'1,MIT FU14D Policy No. 62431594 ESTIMA'T'ED COST OF COiNST'IiMION 3,43.1.40
z (This section need not be completed if the permit valuation is for$100.00 or less). PIP ItMI'I'FC,f+;SO.i.}1111VIOD
AIiY
r- :) ( ) I certify that in the performance of the work for which this permit is issued, PI'M CIMCK.M 101-000.439-318 3,413.95
1 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
101 Q00-418-OQO $63.QU
subject to the workers' compensation provisions of§ection 3700 of the Labor 5'4'ONG MarlO.N T - -1tEL+ID 100-000-241-000 $."
Code, I shall fo with comply with/ ose p sion
spate: - j 7(o Applicant 6L.. - ..
QWarning: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 application agrees to,&shall, indemnify SUB-TOTAL CONST'RUC..ITON.AND PLAN CHECK $104.45
&hold harmless the City of Indian Wells,its officers,agents and employees. LESS PRE-PAID FEES $0.00
2.Any permit issued as a result of this application becomes null and void if /n
work is not commenced within 180 days from date of issuance of such D '" ' ' _ 0 TO .,PERMIT FUS DUE NOMr $104.45
permit,or cessation of work for 180 days will subject permit to cancellation.
FEB 1
I certify that I have read this application and state that the above information is 3 1996
correct. I agree to comply
ly with all City,and State laws relating to the building g I IIIIIII VIII III VIII IIII 55
construction,and hereby authorize representatives of this C' to enter upon the ;
• ab rnentioned property for inspection purposes. y-----__.. IE
-`
Signature (Owner/Agent) Data 2•rib RECEIPT DATE BY DA R D INSPECTOR
INSPECTION RECORD
I
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings Ducts 1
Slab Grade Return Air I
Steel Combustion Air
Roof Deck Exhaust Fans F
OX to Wrap F.A.U. I
Framing Compressor I
Insulation Vents I
Fireplace P.L. Grills I
Fireplace T.O. Fans&Controls 1
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath {
Drywall-Int.Lath I
I
I
Final I
Final IA' POOLS - SPAS
BLOCKWALL P ROVALS Steel
Set Backs Electric Bond I
Footings Main Drain I
Bond Beam Approval to Cover -
Equipment Location
Underground Electric
Underground Plbg.Test
Final Gas Piping. I
PLUMBING APPROVALS Gas Test
Electric Final
Waste Lines Heater Final 1
Water Piping Plumbing Final I
Plumbing Top Out Equipment Enclosure
Shower Pans O.K for Finish Plaster
Sewer Lateral Pool.Cover •1
Sewer Connection Encapsulation -1
Gas Piping I
Gas Test I
Appliances I
Final I
COMMENTS:
I
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
Final {
Utility Notice(Perm) f