SFD (9601-012)44655 Los Manos Dr
9601-012
LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 4881234 B 1213/95
License # Lic. Class ate
Date Signatureof Contractor n
OWNER -BUILDER DECLARATION
I hereby affirm 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 Policy No.
(This sectid_r nWcVK6fbe completed if the permit valuatiogis f66$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 t se fovisio s.
(,Date:_ L> = Appl cant !J
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 lofrt its application agrees to, & shall, indemnify
& hold harmless the City of. di4 r y 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 wcrk 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.
Ignature (Owner/Agent) 12 .Qp MA d66' Date
ALCM
. P_QBUILDING PE.R.MIT
PERMIT M -
DATE •` .Y/. 'YS
VALUATION & br LOT 1 TRACT ^
JOB SITE ADDRESS 4"55 LOS MANOS DRIVE
APN 604-25-007
OWNER
CONTRACTOR
ROGER SN C'LLENi1Ts`RGE7 t&ASS
ROGER S.NELLENAERGER Vit. ASS
41865 BOAKDWALK 9212
4180-5 BOARDWALK ##212
PALM DESERT CA 92211
PALM DESEV CA 92211
(619)777-7766 CBfl## 185€1
(619)777-7766)
DESIGNERIENGINEER,
HAKE D. 0A.T i,AM
- - - - -
33-163 CATi1FDRAL CANYON D.R.
USE OF PF3tM1T " t'd1i 14 V
CA9'1d1WDRAL =Y. CA 92234 770-7
C,1i#IN'f ?Ii:A.-'fKAC:7' 2.39.13 i?RASE TI .
PLAN 2
FEE DESCRIPTION --
FEES
`I'1 &C7 COl`1TMUC; fIGN 2.11.2.00 SE'
PORC.IUPKC1:0 82.00 SI:
GA1ttWFJC Wf 597,00 SF
F,STIMATED COST OF CONSTRUCTION
128,559.40
PERNUT F EE SUMMARY
PLAN CI'-lUX Fk"E 101-000-439=31.5' $618.71
CONS rPU'C'1'IOc'? FTE. 101-000-418 $741.00
WCHA1NICAL FEE 1014)0(1-421.000 $55.56)
I LECTRWAI. FEE 101 -400 -420 -NO $150.06
PI,UNV3"iN'0 F'F'1d 101.-V)0-419.000 $150A0
STONG.1tarmFEE -ILE.so 100-000>241-t100 $12.56
CRADING FEE. 101-M-423-000 $20.00
IN'rRA.S1'RUC"iU)' E FhE 22sdD1M3-342 SZ.868,05
ART IN P17BWC PLACE,1- -RFSID 701-000-255-000
SUB -TOTAL CONS'TR'UCn N AND PLAN CHECK
$4,687.58
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
S4,697.58
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I J
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel I
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
F.A.U.
FramingCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL A P OVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APP OVALS
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 7Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
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:
Desert Sands Unified School District
Notice. 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 1/3/96
No. 14008
Owner NameRoger Snellenberger & Associates
No. 44655 Street Los Manos Dr.
City La Quinta
APN # 604-265-007
Jurisdiction La Quinta
Permit #
Log #
Zip 92253 Study Area 233
Tract # 23913 Lot # 109 Square Footage 2132
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District does not collect fees on
garages/carports, covered patios/walkways, residential additions under 500 square feet, detached
accessory structures or replacement mobilehomes. It has been determined the above-named owner is
exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 1.72 X 2,132 or $3,667.04
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued. ,
Fees Paid By Roger Snellenberger & Associates ? Telephones 777-77,66
Name on the check ='
.r -01
By Dolores A. Ballesteros
Superintendent `r
Fee collected /exempted by Pauline Pearson Payment Received $3,667.04
Check No. 10634
Signature (.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Coov - Applicant/Receipt Copy - Accouriting